Home and Community Based Services Specialist - San Jose, United States - Santaclara Family Health Plan

Description

FLSA Status:
Non-Exempt


Department:
Health Services


Reports To:
Director, Community Based Programs

Employee Unit:
Employees in this classification are represented by Service Employees International Union (SEIU) Local No. 521.


GENERAL DESCRIPTION OF POSITION

The Home and Community-Based Services (HCBS) Specialist serves as a subject matter expert on the Medi-Cal and Medicare health benefits, home and community-based programs and other long-term services and supports (LTSS) needs of SCFHP members.

In this role, the Specialist provides support for SCFHP care teams as a liaison with the LTSS and community-based organization (CBO) provider community to facilitate member referrals, care coordination and member care transitions across the continuum of care.

ESSENTIAL DUTIES AND RESPONSIBILITIES
To perform this job successfully, an individual must be able to perform each essential duty listed below satisfactorily.

• Serve as a designated HCBS and LTSS Specialist and liaison with the LTSS provider community to help facilitate successful transitions of care for members who move between care settings including facilitating their participation in Interdisciplinary Care Teams (ICTs) as appropriate, and proactively communicating and collaborating for care coordination and referrals.
• Serve as lead liaison with County Department of Social Services In-Home Supportive Services (IHSS) program for SCFHP member referrals, transitional care services, assisting with, tracking, follow-up, reporting, troubleshooting and communication with care managers and provider network.
• Manage and provide direct oversight of SCFHP's community resource platform vendor(s) (e.g. findhelp) utilized by member-facing staff, members, delegates, and providers including the development, monitoring, analysis of key performance indicators and report cards for health benefits, food, housing, transit, and financial support.
• Produce and distribute internal reports and metrics that inform regulatory reporting and internal dashboards related to LTSS and community-based program utilization for members. Conduct outreach, and promote SCFHP provider claiming of programs and use of closed loop feature on community resource platform reporting and identifying gaps; mapping out opportunities within the county/available directory.
• Serve as the subject matter expert on HBCS and benefits by maintaining updated knowledge of the full spectrum of benefits including coverage and payment rules for Medi-Cal and Medicare lines of business, Enhanced Care Management, Community Supports (CS), public benefits addressing social determinants of health (SDOH), Transitional Care Services (TCS), and utilization management policies and procedures.
• Develop and conduct annual training on HCBS benefits and programs, SCFHP contracted community supports, and the full spectrum of community resources supporting transitions of care including eligibility and referrals for the internal utilization and case management team and as needed for physicians, clinics, skilled nursing facilities, community based organizations, ECM providers, delegates, and staff.
• Contribute to the development and updates of Memorandums of Understanding (MOUs) and other partnership agreements with LTSS and HCBS providers including but not limited to, IHSS, Public Authority, Multipurpose Senior Services Program (MSSP), Caregiver Resource Providers, and other required Department of Health Care Services (DHCS) and Centers for Medicare and Medicaid Services (CMS) directives.
• Provide targeted training, consultation and support to providers and care managers on the Interdisciplinary Care Teams (ICT) with navigating member referrals and access to community based programs, LTSS benefits and services, with an emphasis on transitional care services.
• Conduct outreach and provide education in collaboration with the Marketing Department and other internal teams to produce member-and provider-facing materials with information about eligibility and access to LTSS benefits and community-based services in the office, home, hospital, facilities, and community.
• Manage the day-to-day workflow and follow up for all referrals to the LTSS/HCBS/CBP HelpDesk phone and e-mail queue, and respond to requests from members, staff, delegates and providers.
• Build rapport with safety network providers, maintain knowledge of current public and community based resources and share updates through various communication stream,

directly with case management and other member-facing teams, and attend regular and on-going community meetings.

• Identify, track and trend issues, problem patterns and quality and prepare recommendations for potential process and/or service improvements within the scope of this position.
• Support process improvement projects for the integration of HCBS with internal utilization and case management teams, other member-facing staff and external partners.
• Attend and actively participate in regular departmental meetings, in-services, training and coaching sessions, and external stakeholder meetings.
• Perform other duties as required or assigned.

REQUIREMENTS - Required (R) Desired (D)

The requirements listed below are representative of the knowledge, skill, and/or ability required or desired.

• Bachelor's Degree in a health-related or social services field or equivalent experience, training or coursework. (R)
• Minimum three years of relevant experience in a healthcare or community-based setting serving the Medi-Cal, Medicare and/or Long Term Services and Supports (LTSS) population(s). (R)
• Experience working with designated member population and community-based providers (e.g. LTSS, skilled nursing facilities, community-based organizations, county health departments). (R)
• Knowledge of case management, transitional care services, community resources, and available community-based programs in Santa Clara County. (R)
• Experience preparing and delivering training materials and presentations. (D)
• Maintenance of a valid California driver's license and acceptable driving record, in order to drive to and from offsite meetings or events; or ability to use other means of transportation to attend offsite meetings or events. (R)
• Knowledge of Santa Clara County Health and Social Services. (D)
• Ability to work within an interdisciplinary team structure. (R)
• Working knowledge of and the ability to efficiently operate all applicable computer software including computer applications such as Outlook, Microsoft, Excel, and specific case management programs. (R)
• Excellent communication skills including the ability to express oneself clearly and concisely when providing service to SCFHP internal departments, members, providers and outside entities over the telephone, in person or in writing. (R)
• Ability to think and work effectively under pressure and accurately prioritize and complete tasks within established timeframes. (R)
• Ability to assume responsibility and exercise good judgment when making decisions within the scope of the position. (R)
• Ability to consistently meet accuracy and timeline requirements to maintain regulatory compliance. (R)
• Travel to off-site locations for work such as in office, home, facility, clinic, and other community settings. (R)
• Ability to maintain confidentiality. (R)
• Ability to comply with all SCFHP policies and procedures. (R)
• Ability to perform the job safely and with respect to others, to property and to individual safety. (R)

WORKING CONDITIONS Generally, duties are primarily performed in an office environment while sitting or standing at a desk.

Incumbents are subject to frequent contact with and interruptions by co-workers, supervisors, and plan members or providers in person, by telephone, and by work-related electronic communications.

PHYSICAL REQUIREMENTS
Incumbents must be able to perform the essential functions of this job, with or without reasonable accommodation:

Mobility Requirements:
regular bending at the waist, and reaching overhead, above the shoulders and horizontally, to retrieve and store files and supplies and sit or stand for extended periods of time; (R)

Lifting Requirements:
regularly lift and carry files, notebooks, and office supplies that may weigh up to 5 pounds; (R)

Visual Requirements:
ability to read information in printed materials and on a computer screen; perform close-up work; clarity of vision is required at 20 inches or less; (R)

Dexterity Requirements:
regular use of hands, wrists, and finger movements; ability to perform repetitive motion (keyboard); writing (note-taking); ability to operate a computer keyboard and other office equipment (R)

Hearing/Talking Requirements:
ability to hear normal speech, hear and talk to exchange information in person and on telephone; (R)

Reasoning Requirements:

ability to think and work effectively under pressure; ability to effectively serve customers; decision making, maintain a concentrated level of attention to information communicated in person and by telephone throughout a typical workday; attention to detail.

(R)


ENVIRONMENTAL CONDITIONS
General office conditions. May be exposed to moderate noise levels.