Meals on Wheels Orange County is the largest nonprofit provider of nutrition and supportive services for at-risk older adults. It is committed to erasing hunger and loneliness for at-risk older adults through nutritious meals, friendly visits and safety checks, and keeping families together through day services. Through its critical services, the organization delivers nearly 2 million meals to 20,000 at-risk older adults each year throughout Central and North Orange County. Meals on Wheels Orange County is a dba of Community SeniorServ, Inc.

Hours: Mon-Fri, 8:00 am-4:30 pm
Rate Level Position: Rate varies depending on experience
Location: Santa Ana, Ca

We are excited to share the hourly range for this position is $24.00 - $26.00 hour, exclusive of fringe benefits. If you are hired at MOWOC, your final compensation will be determined based on factors such as geographic location, skills, education, and/or experience in addition to internal pay. Hiring at the maximum of the range would not be typical in order to allow for future & continued salary growth.

JOB SUMMARY: The Care Coordinator Specialist II ensures patient navigation is implemented by managing client caseloads, conducting intake assessment and reassessment, and advice support Care Coordinators. The CCS II facilitate conversations between interdisciplinary Care Teams (including Care Coordinators, primary care physicians, and additional health care providers) and expedite client services referrals. The CCS II provides support to in the field and supports “high-risk” members and their family/caregiver(s), clinic/hospital/specialty providers and staff, and community resources in a team approach:

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Coordinate with those individuals and/or entities to ensure a seamless experience for the member and non-duplication of services.
• Increase continuity of care by managing relationships with tertiary care providers, transitions-in-care, and referrals
• Screen clients for eligibility for direct and support services and refer clients to needed services, such as mental health, housing, crisis, and employment assistance
• Conducts client-specific assessment of needs; identifies problems and establishes client-centered immediate requirements and long-range goals.
• Arranges and coordinates a network of supportive services and entitlements (formal and informal) consistent with mutually-developed care plan.
• Maintains required records and reports in compliance with department, agency, local, state and federal requirements.
• Schedules and attends meetings to provide program information
• Represents the program with staff and clients and in networking meetings, speakers’ bureaus, and trainings.
• Accompany member to office visits, as needed and according to the Plan guidelines.
• Assumes responsibility for all case records and monthly statistics.
• Responsible for meeting program targets
• Responsible for meeting departmental goals and key metrics as approved by Senior Management.
• Attends and participates in all mandatory training sessions and meetings (including CPR and First Aid training) as prescribed by state regulations.
• Completes Home Visits, Hospital, and meet with the patient where they are at
• Develop and coordinate monthly schedules for transportation needs of residents with the transportation provider, Supportive Services team, and residents.
• Administer Transportation registration including maintaining registration list, attendance records, documentation for compliance and provide the information to appropriate partners.
• Accompany residents on scheduled trips to ensure the safety and well-being of resident participants.
• Coordinate with hospital, SNF staff on discharge plans
• Connect member to other social services and supports the member may need, including transportation.
• Other duties and special projects as assigned.

EDUCATION, EXPERIENCE AND QUALIFICATIONS:

• Bachelor’s Degree in Social Work or Social Services, Gerontology, or Health Sciences.
• Licensed Vocational Nurse (LVN) a plus.
• Bilingual in Spanish or threshold language.
• Prior experience with Care Transitions Program and Methodology
• Minimum of 2 years experienced case management, enhanced case management, Care transitions
• Minimum of 2 years experienced working with older adults, elderly and people with disabilities.
• Experience providing administrative support, report development, and development and dissemination of materials and tools for new program development preferred.
• Excellent communication, written, and interpersonal skills.
• Thorough knowledge of case management principles and techniques.
• Maintains professional and confidential standards in client business-related activities.
• Demonstrates a “can-do” spirit, a sense of optimism, and commitment.
• Good problem-solving skills and critical thinking skills required.
• Ability to identify client/patient and family needs; develop cooperative working relations with community resources, informal support sources, and other employees; connect client to appropriate resources.
• Working knowledge of programs and services available in Orange County for seniors.
• Proficient in Microsoft Office Suite (Word, Excel, Outlook).
• Must pass background check.

PHYSICAL JOB REQUIREMENTS:

• Frequently remains in a stationary position and traverses locations.
• Frequently operates equipment, computers, or tools.
• Frequently extends body, arms or hands as needed to perform essential duties and responsibilities.
• Occasionally ascends/descends as needed to complete essential duties and responsibilities.
• Constantly speaks, communicates, interprets or exchanges information accurately.
• Constantly perceives objects over moderate or long distances, with or without accommodation.
• Occasionally distinguishes differences or similarities in intensity or quality of odors.
• Occasionally moves, transports, and positions objects weighing up to 50 pounds.

Meals on Wheels OC is an equal opportunity employer