Job description

Position Summary:
Under the direction and supervision of the PACE IDT Supervisor, the PACE IDT Coordinator will be responsible for assisting PACE participants in connecting them to PACE system of care and serve as a liaison between PACE participants and all PACE disciplines, specialty providers, caregivers/family members etc. The PACE IDT Coordinator will be the primary point of contact and will be responsible for assisting participants with referrals, appointments, scheduling, transportation services, translation, and ensuring that participants receive the highest quality of services.

Essential Functions of the Job:

• Welcomes and conducts tours of facility to all new participants/or as required.
• Responsible for warmly welcoming new enrollees to PACE program, building rapport, retrieving information necessarily to provide adequate medical management.
• Daily participation in IDT meetings; provide timely follow up in the coordination of services to PACE participants and reporting outcomes in a timely manner to the IDT team.
• Responsible for scheduling of all initial assessments, re-assessments, annuals and change of condition with the required disciplines.
• Works closely with Access to Care/Referrals, Transportation, Therapy, and medical departments.
• Provide timely, high-quality information, referral services to participants linking them to San Diego PACE services and any required medical, social, mental appointments
• Coordinates appropriate internal, external referrals and services to PACE participants including transportation, day center attendance, therapy, medication, meals on wheels, supplies, DME, personal care, etc.
• Conducts home visits, hospital visits, SNF facilities, etc. visits as required
• Ensure daily proper documentation in Truchart and will ensure to add any relevant information in alert section.
• Oversee care coach for all participants assigned to panel, follows up on care coach, and on call services messages within 24 hours. Help address any participants’ inquiries, providing guidance and assistance with any coordination and delivery of services.
• Always provide high quality and excellent customer service. Will address any concerns/complaints in a timely manner
• Acts as a liaison between different disciplines, services and participants to ensure continuity of care and services. Confirms with care team and PCP that specialist notes (requesting from facility, emailing to SNF MD), as needed
• Assists management with related special projects including implementation of satisfaction surveys
• Maintains program specific records as required and submits reports as requested in a timely manner
• Responsible for tracking appointments -routine appts in place made by Clinical Coordinators or Access to Care needing transportation and/or companion to ensure proper execution. Follows up on new appts requested from specialists for appropriate follow ups (usually needing new referral to be placed and following through with appointment being completed)

Additional Duties and Responsibilities:

• Maintains established departmental policies and procedures, objectives quality assurance program, safety and environmental.
• Enhances professional growth and development through participation in educational programs, current literature, in-service meetings, and workshops.
• Attends meetings as required and participates in committees as directed.
• Performs other related duties as assigned or requested.
• Enhances professional growth and development through participation in educational programs current literature, in-service meetings and workshops
• Adheres to and models SYHC’s core values and behaviors of Excellence, Empowerment, Integrity and Respect.
• Adheres to SYHC and PACE excellent attendance and punctuality policies and practices.
• Assists participants to fill out Adult Meal Benefit, HIPAA, Consents, and any required
• Flexible and open to change
• Performs other related duties as assigned or requested.

Job Requirements

Education Required (Minimum level of education):
High School Diploma or GED equivalent required. Bachelor’s Degree preferred in Social Services, Psychology, Health Science or related field.

Experience Required (Minimum level of experience):
A minimum of one year experience working with the elderly and healthcare industry.

Verbal and Written Skills Required to Perform the Job:
Must have excellent oral and written communication skills. Bilingual (English/Spanish required)

Technical Knowledge and Skills Required Performing the Job: Proficient in Microsoft applications and use of electronic health data systems, At a minimum level have good computer literacy including internet navigation and research skills.

Competencies:
Demonstrates ability to be culturally sensitive and respect diversity, work effectively with individuals of different cultures and socio-economic status; passion for service; self-starter and highly organized; ability to prioritize, and complete a large volume of work within strict time deadlines; provide prompt, efficient and responsive customer service.

Equipment Used:
Computers, phones, personal vehicles, copy machines and fax machines and other office equipment.

Working Conditions and Physical Requirements:
Must be willing to work on site or as required by the program; must be open to conduct visits to participants/families as needed.

About Us San Ysidro Health is a Federally Qualified Health Care organization committed to providing high quality, compassionate, accessible and affordable healthcare services for the entire family. The organization was founded by seven women in search of medical services for their families and community. Almost 50 years later, San Ysidro Health now provides innovative care to over 108,000 patients through a vast and integrated network of 47 program sites across the county. San Ysidro Health could not serve our patients without the dedication of our passionate and hardworking employees. Apply today and become a part of our mission-driven team! San Ysidro Health has a long-standing commitment to equal employment opportunity for all applicants for employment. Employment decisions including, but not limited to, those such as employee selection, performance evaluation, administration of benefits, working conditions, employee programs, transfers, position changes, training, disciplinary action, compensation, and separations are made without regard to race, color, religion (including religious dress and grooming), creed, national origin, nationality, citizenship status, domestic partnership status, ancestry, gender, affectional or sexual orientation, gender identity or expression, marital status, civil union status, family status, age, mental or physical disability (including AIDS or HIV-related status), atypical heredity cellular or blood trait of an individual, genetic information or refusal to submit to a genetic test or make available the results of a genetic test, military status, veteran status, or any other characteristic protected by applicable federal, state, or local laws.

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