Marin Community Clinics, founded in 1972, is today, a multi-clinic network with a wide array of integrated primary care, dental, behavioral, specialty and referral services. As a Federally Qualified Health Center (FQHC), we provide vital health services to almost 40,000 individuals annually in Marin County. The Clinics regularly receive national awards from the Health Resources and Services Administrations (HRSA). Our Mission is to promote health and wellness through excellent, compassionate care for all.

The Lead Complex Care Program Coordinator works as part of a dynamic, multidisciplinary, Complex Care team to advance our goal of improving health outcomes for individuals with complex medical, behavioral health, and psychosocial needs.  Working collaboratively with primary care, behavioral health, and other members of the clinical care team, the Lead Complex Care Program Coordinator works as a member of an expert team of professionals to provide patient-centered, outcome- driven care that promotes independence and dignity.

The Lead Program Coordinator will provide comprehensive eligibility assessments, outreach and engagement, care planning, and administrative coordination, with the goals of minimizing barriers to care, improving health outcomes, and ensuring an efficient system of care. In addition, the Lead Program Coordinator will ensure that administrative and programmatic goals are met including maximum enrollment, timely referral processing, QIP goals, and timely collaboration/communication with integrated care team members. Additionally, the Lead Program Coordinator will be responsible for training/orienting all new Associate Case Managers (ACMs) on Complex Care workflows.  The Lead Complex Care Program Coordinator role is a patient-facing role that aims to build engagement and trust with our Complex Care patients.

*This position is currently a hybrid telework/in-clinic position. 

• Trains/orients all new Associate Case Managers.
• As member of the Complex Care leadership team, provides input and feedback re: workflows, goals, hiring, and best practices.
• Provide oversight to Complex Care referral queue.
• Provide oversight of QIP metrics and reporting to PHC.
• Track and submit capacity reports.
• Participate in PHC CalAIM monthly roundtables and informational presentations.
• Conduct initial patient outreach and engagement.
• Collaborate with Complex Care Clinical Supervisors to coordinate case conferencing and case assignment with Case Managers.
• Submit and manage Treatment Authorization Requests to managed care plans.
• Ensure all program reporting requirements are met.
• Assist Patients to complete necessary forms/applications.
• Assist patients to schedule/attend medical, BH, and specialist appointments.
• Conduct home/community visits as needed.
• Consult/coordinate with interdisciplinary care team, including behavioral health, care navigation MAs, nursing, medical providers, and external partners.
• Document all Patient interactions and services using MCC’s electronic health record and secondary database.
• Attend internal and external meetings (i.e. case conferencing, administrative).
• Attending trainings such as health coaching, engagement techniques, etc.
• Timely and accurate reporting of data as requested to MCC CM programs.
• Provide frank and considered opinions regarding case management services and quality improvement measures.
• Provide services to satellite clinics as needed.
• Other duties may be assigned.

Education and Experience:

• Medical Assistant (MA) or Bachelors degree in related subject or equivalent education and experience in healthcare setting.
• Familiarity with CalAIM initiative and requirements.
• Experience with administrative/operations management.
• 1-2 years’ experience (and passion for) providing support to individuals with chronic and complex BH needs, complex medical conditions and/or substance-using individuals.
• Knowledge of state regulations and legal/ethical standards related to patient rights, and client/patient confidentiality required.
• Experience training in motivational interviewing or willingness to learn.
• Current CPR Training Current
• Valid CA Driver’s License

 Required Skills and Abilities:

• Familiarity with eligibility criteria for existing MCC Case Management programs including CalAIM, Healthy Steps, Enhanced Care Clinic, WFW, and CPSP. 
• Knowledge of reporting requirements for case management programs.
• Ability to effectively triage and prioritize referrals.
• Ability to effectively engage new patients and conduct initial needs assessments.
• Excellent organizational skills necessary for tracking caseloads.
• Understanding of the interplay between chronic conditions and psychosocial issues. 
• Comfortable working with individuals with complex behavioral health presentations and/or substance use disorders.
• Passion for helping individuals navigate a complex system of care.
• Able to work as part of a team; welcomes guidance from multidisciplinary team members.
• Demonstrated initiative, creativity, and problem-solving skills.
• Is comfortable working with community partners including community-based organizations (CBOs), Marin County, medical/BH specialists, and insurance providers.
• Ascribes to the tenets of person-centered, trauma-informed, housing-first care.
• Demonstrated compassion and respect for individuals served in all interactions.
• Demonstrated willingness to be flexible and adaptable in all aspects of this work.

Physical Requirements:

• Fulfill immunization and fit for duty regulatory requirements.
• Prolonged standing and walking.
• Prolonged periods of sitting at a desk and working on a computer with keyboard and mouse.
• Must be able to lift up to 15 pounds at times.
• May travel between clinics or meet Patients in the community as needed.

Benefits:
Our benefits program is designed to protect your health, family and way of life. We offer a competitive Benefits Program that includes affordable health insurance and Health Reimbursement Accounts (HRA), Dental and Vision Insurance, Educational and Continuing Education Benefits, Student Loan Repayment and Loan Forgiveness, Retirement Plan, Group Life and AD&D Insurance, Short term and Long Term Disability benefits, Professional Fee Reimbursement, Mileage and Cell Phone Reimbursement, Scrubs Reimbursement, Loupes Reimbursement, Employee Assistance Programs, Paid Holidays, Personal Days of Celebration, Paid time off, and Extended Illness Benefits.


Marin Community Clinics is an Equal Employment Opportunity Employer