Under the strategic direction of the Chief Clinical Officer / Medical Director, the Care Plan Coordinator oversees the comprehensive lifecycle of care plan activities. Key responsibilities include the direct supervision of assigned Interdisciplinary Team (IDT) personnel and the optimization of service delivery to ensure High Desert PACE participants receive integrated, high-quality care.

Position Responsibilities

• Participate as a member of the interdisciplinary team, facilitate Care Planning meetings and provide leadership for effective care planning and problem solving for quality participant service.
• Responsible for the effective operation of the Care Planning Activities, including the routine requirements to meet participant needs; involves rigorous communication and coordination with all HDP departments.
• Responsible for communicating directly with interdisciplinary team staff, including home care coordinator, clinic nurse manager, social workers, activities coordinator, physical therapist, occupational therapists, dietitian, transportation coordinator, and personnel care attendants; and other center staff as assigned.
• The Care Planning Coordinator will assist with development, oversight, implementation, and adherence to policies, procedures, and standards for all Care Planning Activities.
• Responsible for meeting Care Planning deadlines to maintain compliance.
• Responsible for the oversight of Care Planning logs and monitor for compliance.
• Send bi-monthly status reports on overall Care Planning compliance directly to the Chief Clinical Officer.
• Constant communication with staff regarding real-time data Care Planning data and timely report to Chief Clinical Officer if any issues arise.
• Maintain documentation regarding annual participant recertification and maintain compliance.
• Ensure that the Care Plans are signed and activated within the allotted timeframe as specified in the HDP Policies and Procedures manual.
• Participate in and contribute to HDP management team.
• Responsible for adherence to all regulations, both federal and state, which govern the operations of a PACE organization and a licensed adult day care center.
• Maintain confidentiality regarding participant, staff, contractor, and organizational information.
• Attend and participate in staff meetings, in-services, projects, and committees as assigned.
• Adhere to and support the center’s policies, practices, and procedures.
• Accept assigned duties in a cooperative manner; and perform all other related duties as assigned.
• Be flexible in schedule of hours worked.
• May require use of personal vehicle.

Education & Training

• Minimum of two (2) years of experience in a supervisory or clinical administrative role in a health care delivery setting.
• Minimum of one (1) year of documented experience working with a frail or elderly population.
• High School Diploma or GED needed.
• Associate’s degree in health care related areas is preferred.
• Bachelor’s degree in health care administration, nursing, public health preferred.
• Must be medically cleared for communicable diseases and has all immunizations up to date before engaging in direct participant contact.

Skills & Abilities

• Analytical, with highly developed leadership skills.
• Thorough knowledge of current concepts and practices of health and social services to the elderly, particularly of home- and community-based services, interdisciplinary team facilitation model.
• Knowledge of utilization review, quality assurance, and health care concepts.
• Knowledgeable as an advocate for risk-based long-term care programs, specifically the PACE model.
• Excellent planning and coordination abilities.
• Ability to work effectively and harmoniously with staff, the elderly, providers of services, and peers.
• Energetic, well organized, dependable, flexible, and resourceful.
• Effective oral and written communication skills.
• Working knowledge of desktop application software (Microsoft Office).
• Multi-language skills preferred

Working Conditions

The working conditions and physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Must be able to work required schedule.
• Requires physical strength to perform essential functions of the job.
• Occasional travel between sites, nursing/group homes and to members’ homes required.
• Requires use of personal vehicle.
• Requires valid driver’s license.
• Requires proof of automobile insurance coverage at the following minimum amounts to be reimbursed for mileage.
• May require use of personal cell phone for business purposes (may be eligible for stipend)