About Us: Meals on Wheels Orange County is the largest nonprofit provider of nutrition and supportive services for at-risk older adults in Central and North Orange County. Our mission is to combat hunger and loneliness among older adults through nutritious meals, friendly visits, and safety checks, and to support families through day services. We deliver nearly 2 million meals annually to 20,000 at-risk older adults.

Location: Santa Ana, CA

Hours: Monday - Friday, 8:00 AM - 4:30 PM

Hourly Range: $18.25 - $23.00 per hour (Hourly rate will be determined based on factors such as geographic location, skills, education, and experience)

JOB SUMMARY: The Care Coordinator ensures patient navigation is implemented by managing client caseloads, conducting intake assessment and reassessment. The Care Coordinator is responsible for performing duties for the Care Coordination program to include: Supportive Housing Programs, Enhanced Care Management, Care Transitions Service as well as promoting the benefits Meals on Wheels OC services.

Note: Special roles and responsibilities may be applicable to contract / regulatory program requirements.

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, transition-in-care, and referrals
• Screen members for eligibility for direct and support services and refer members to needed services, such as mental health, housing, Medically Tailored Meals, ECM, and MoWOC programs
• Conducts member assessment; identifies problems and establishes client-centered immediate requirements and long-range goals. (Contract/ Program Requirement)
• Arranges and coordinates a network of supportive services and entitlements (formal and informal) consistent with a mutually developed care plan.
• Maintains required records and reports in compliance with department, agency, local, state and federal requirements.
• Assumes responsibility for all case records and monthly statistics.
• Responsible for meeting program targets
• 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 skilled nursing facility visits (Contract/ Program Requirement)
• Coordinate with hospital, SNF staff on discharge plans (Contract/ Program Requirement)
• Develop and coordinate monthly schedules for transportation needs of residents with the transportation provider, Supportive Services team, and residents.
• Other duties and special projects as assigned.

EDUCATION, EXPERIENCE AND QUALIFICATIONS:

• Medical assistant certification preferred and or related educational certification
• Case management experienced preferred
• Experienced working with older adults, elderly and people with disabilities.
• 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.
• Working knowledge of programs and services available in Orange County for seniors.
• Proficient in Microsoft Office Suite (Word, Excel, Outlook).
• Strong understanding of cultural competency with the target population
• 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 Orange County is an equal-opportunity employer and encourages applications

from individuals of all backgrounds and experiences. We are committed to creating an inclusive and

supportive work environment.