Case Manager II (4478)

LIFELONG MEDICAL CARE•Oakland, CA

20h•Hybrid

About The Position

The Case Manager II (CM II) is a key member of the primary care interdisciplinary team, providing services for patients with complex care needs. This position involves patient outreach, engagement, psychosocial service assessment, and assisting in developing patient-centered care plans. The CM II leads the implementation of Enhanced Care Management (ECM) and coordinates service referrals and delivery. This role requires meeting clients in various settings including home, clinic, or community, and often provides care outside of a traditional health center, such as home visits, hospitals, supportive housing sites, encampments, and shelters. The ideal candidate demonstrates a strong commitment to working directly with low-income persons from diverse backgrounds in a culturally responsive manner, adhering to principles of harm reduction, recovery, housing first, age-friendly, and patient-centered care. Strong organizational, administrative, problem-solving, interpersonal, verbal, and written skills are essential, along with the ability to prioritize tasks, work under pressure, and adapt to change while maintaining a positive attitude. The role requires both independent judgment and effective teamwork, with a commitment to continual learning and improvement. This position is represented by SEIU-UHW, and salaries and benefits are set by a collective bargaining agreement (CBA).

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 like Word, Excel, and Outlook, as well as the ability to work in and/or manage databases
Access to reliable transportation with current license and insurance

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

Outreach, via telephone and in person at LifeLong, community and residential sites, to patients who meet case management program eligibility criteria or are prioritized by LifeLong for this service
Proactively meet and engage with patients to build effective relationships and assess strengths and needs through use of standard intake, screening tools, and health, and social services records review
Actively involve patients and caregivers, as appropriate, in designing and delivering services, including development of care plans, assuring alignment with patients’ values and expressed goals of care
Provide and facilitate referrals for internal and external resources, and collaborate with the patient to complete required applications, forms, or releases of information
Maintain a patient caseload in accordance with LifeLong standards for the specific population served or site requirements
Utilize data registries and reports to manage caseload, meet program requirements, maintain grant deliverables, and promote high quality care
Provide health education and training to patients, including but not limited to, harm reduction and disease risk-mitigation strategies that empower patients to manage their own health and wellness (e.g. overdose prevention, mitigating spread of communicable diseases)
Assist patients with accessing and retaining public benefits and insurance (e.g. MediCal, SSI/SSDI, CalFresh, General Assistance, etc), and affordable/subsidized housing
Respectfully and routinely communicate with patients, their care team members, external partners, and identified social supports
Maintain knowledge of patients’ medical/behavioral health treatment plans and facilitate utilization of services by providing resources such as accompaniment, transportation, in-home care, reminder calls etc.
Participate in team meetings to coordinate care, support patient goals, and reduce barriers to accessing services
Advocate on behalf of patients to get their needs met and/or support patients to learn advocacy strategies for themselves.
Provide case management services to patients with multiple complex acute or chronic medical or behavioral health conditions (e.g. HIV/AIDS, Hep C, congestive heart failure, severe diabetes, severe hypertension, psychosis, pregnancy, and homelessness)
Provide general housing case management services that includes document readiness, housing problem solving, and assessments for Coordinated Entry System
Assist with patient crisis intervention and de-escalation
Provide and document billable services to eligible populations that result in revenue generation for LifeLong
Keep current on community resources and social service supports to effectively serve the target population
Document patient contacts/services in required data systems (EHR, HMIS etc.) according to LifeLong policy
Promote diversity, equity, inclusion, and belonging in support of patients and staff
Represent LifeLong positively in the community and advocate on behalf of underserved populations