Case Manager II (4603)

LIFELONG MEDICAL CARE•San Pablo, CA

11d•Hybrid

About The Position

The Case Manager II (CM II) is a vital part of the primary care interdisciplinary team, dedicated to serving patients with complex care needs. This role involves patient outreach, engagement, and psychosocial assessments. The CM II assists in creating patient-centered care plans, leads the implementation of Enhanced Care Management (ECM), and coordinates service referrals and delivery. Services can be provided in various settings including homes, clinics, community sites, hospitals, supportive housing, encampments, and shelters, catering to specific populations with multifaceted health and social service requirements. This position is union-represented, with salaries and benefits governed by a collective bargaining agreement (CBA) with SEIU-UHW, requiring employees to maintain good standing within the union.

Requirements

High School diploma or GED
At least two (2) years of progressively responsible work or volunteer experience in a community-based health care or social work setting OR at least one (1) year of experience as a Case Manager I or equivalent position
Proficient skills using Microsoft Office applications (Word, Excel, Outlook)
Ability to work in and/or manage databases
Access to reliable transportation with current license and insurance
Commitment to working directly with low-income persons from diverse backgrounds in a culturally responsive manner
Commitment to harm reduction, recovery, housing first, age-friendly and patient centered care
Strong organizational, administrative and problem-solving skills
Ability to be flexible and adaptive to change while maintaining a positive attitude
Excellent interpersonal, verbal, and written skills
Ability to prioritize tasks, work under pressure, and complete assignments in a timely manner
Ability to seek direction/approval on essential matters, yet work independently, using professional judgment and diplomacy
Works well in a team-oriented environment
Conducts oneself in external settings in a way that reflects positively on your employer
Ability to be creative, mature, proactive, and committed to continual learning and improvement in professional settings

Nice To Haves

Bachelor’s Degree in Social Work, or another Health or Human Services field
Work or lived experience in area(s) relevant to the population to be served: e.g. perinatal, homelessness, recovery, criminal justice, elder care, palliative and end-of-life care, or behavioral health

Responsibilities

Conduct outreach via telephone and in person at LifeLong, community, and residential sites to eligible patients or those prioritized for case management services.
Engage with patients to build relationships and assess strengths and needs using standard intake, screening tools, and review of health and social services records.
Involve patients and caregivers in designing and delivering services, including care plan development aligned with patient values and goals.
Provide and facilitate referrals for internal and external resources, assisting patients with applications, forms, and releases of information.
Manage a patient caseload according to LifeLong standards, utilizing data registries and reports to meet program requirements, grant deliverables, and ensure high-quality care.
Provide health education and training, including harm reduction and disease risk-mitigation strategies (e.g., overdose prevention, communicable disease mitigation).
Assist patients in accessing and retaining public benefits, insurance (MediCal, SSI/SSDI, CalFresh, General Assistance), and affordable housing.
Communicate respectfully and routinely with patients, care team members, external partners, and social supports.
Maintain knowledge of patients’ medical/behavioral health treatment plans and facilitate service utilization through accompaniment, transportation, reminder calls, etc.
Participate in team meetings to coordinate care, support patient goals, and reduce barriers to accessing services.
Advocate for patients to meet their needs and support patients in developing their own advocacy skills.
Provide case management services for patients with complex acute or chronic medical or behavioral health conditions (e.g., HIV/AIDS, Hep C, congestive heart failure, severe diabetes, severe hypertension, psychosis, pregnancy, homelessness).
Offer general housing case management services, including document readiness, housing problem-solving, and assessments for the Coordinated Entry System.
Assist with patient crisis intervention and de-escalation.
Provide and document billable services to eligible populations for revenue generation.
Stay current on community resources and social service supports.
Document patient contacts and services in required data systems (EHR, HMIS) according to LifeLong policy.
Promote diversity, equity, inclusion, and belonging for patients and staff.
Represent LifeLong positively in the community and advocate for underserved populations.