Case Manager III (5170)

LIFELONG MEDICAL CARE•Alameda, CA

5d•$29 - $34•Hybrid

About The Position

The Case Manager III (CM III) is a key member of the primary care interdisciplinary team, providing services for patients with complex care needs. This position conducts patient outreach, engagement, and psychosocial service assessment, assists in developing a patient-centered care plan, is the lead implementer of Enhanced Case Management (ECM), and coordinates service referrals and delivery. The case manager meets clients in home, clinic, or community as appropriate or required by the specific program/site. The CM III provides services to specific populations that have multiple complex health and social services needs and often provides care outside of a traditional health center setting, such as home visits, hospitals, supportive housing sites, encampments, and shelters. In addition, they provide comprehensive housing navigation support to clients. This position is represented by SEIU-UHW. Salaries and benefits are set by a collective bargaining agreement (CBA), and an employee in this position must remain a member in good standing of SEIU-UHW, as defined in the CBA. LifeLong Medical Care provides high-quality care for medical, dental, and behavioral health needs as well as social services to underserved people of all ages; creates models of care for the elderly, people with disabilities and families; and advocates for continuous improvements in the health of our communities across Oakland, Berkeley, and West Contra Costa County. From opening a residential respite program for homeless persons discharged from the hospital to offering free COVID testing to the community, we are innovative and responsive to our times' social and medical needs. We provide an inclusive workplace that promotes and values diversity and with which our patients can identify. To this end, we seek candidates who reflect the diversity of the East Bay communities we serve.

Requirements

High School diploma or GED
At least three (3) 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 II or equivalent position or registration or certification as a Certified Alcohol and Drug Counselor by one of the two certifying bodies in California
Or A Master’s degree in social work and registration as an Associate Social Worker with the California Board of Behavioral Sciences can be substituted for the 2 years of experience requirement.
Working knowledge of the local behavioral health service system.
Familiarity with evidence-based practices for behavioral health disorders.
Experience in clinical case management and harm reduction.
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

Lived experience relative to working with people experiencing homelessness (e.g. formerly homeless, social or behavioral health services consumer, criminal justice system involvement, foster care involvement, close family-member of someone with these experiences).

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), 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 reducing barriers to accessing services
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
Assess patients to identify cognitive and/or behavioral health needs and provide brief interventions and short-term support using standardized tools and effective approaches for patient care
Co-facilitate patient groups
Provide intensive case management to a caseload size in accordance with site or program standards focusing on a subset of the highest acuity patients
Provide specialized housing navigation services to patients who are matched to a housing resource through Coordinated Entry System
Lead crisis intervention response, de-escalation procedures, notification of the local mental health department and/or crisis response team, and follow-up care
Provide and document billable services to eligible populations that result in revenue generation for LifeLong
Advocate on behalf of patients to get their needs met and/or support patients to learn advocacy strategies for themselves.
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
Specific activities may vary depending on the requirements of the program and funder
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