Case Manager, Medical

SACRAMENTO NATIVE AMERICAN HEALTH CENTER INC•Sacramento, CA

4d•$25 - $27•Onsite

About The Position

The Medical Case Manager provides comprehensive case management and care coordination for patients with complex physical, behavioral, dental, and social needs. The role primarily manages an assigned patient panel while providing support to other patients as needed. Responsibilities include referrals, patient interviews, data collection, confidential record-keeping, patient recruitment, and helping patients establish care at SNAHC. The Case Manager works closely with program stakeholders, healthcare providers and payors, social services agencies, and community-based organizations to coordinate services and support patients. The role may require floating to other SNAHC locations and travel between sites for coverage or meetings. The position may be grant funded; continued employment depends on renewed or additional funding and may end when the grant cycle closes. Grant funding does not create a contractual right to employment for a specific period, and SNAHC remains an at-will employer.

Requirements

At least two years of experience in health, social services, or a related field.
Experience working in an Electronic Health Record environment.
Experience and knowledge related to the culture and environmental issues significant to homeless individuals, low-income families, mental health patients, and individuals involved in the criminal justice system.
Experience with interventions such as motivational interviewing, de-escalation, harm reduction, and trauma-informed care in a diverse clinical setting.
Excellent computer skills, preferably with Windows and Microsoft Office Suite.
Excellent telephone and communication skills.
Excellent organizational, writing, and verbal skills.
Ability to work independently, set priorities, and work well under pressure.
Ability to maintain a high degree of confidentiality.
Ability to demonstrate professionalism when interacting with patients, subordinates, colleagues, community members, and vendors.
Ability to collaborate and convene across sectors and organizational levels.

Nice To Haves

Bachelor’s degree or equivalent work experience in health, social services, or a related field.
Knowledge and experience using Electronic Health/Administrative Records and Resource Patient Management Systems NextGen.
Experience in an FQHC setting.
Knowledge of and experience with Social Determinants of Health.
Knowledge of traditional, cultural, and spiritual practices of the diverse AI/AN community, and ability to work with racially, culturally, ethnically, and financially diverse populations.
Bilingual.

Responsibilities

Coordinate referrals to appropriate programs based on eligibility criteria, patient needs, and provider assignment.
Assist with durable medical equipment referrals for the medical department.
Meet weekly productivity goals.
Assess patients’ health status, regional resource utilization, and barriers to care; develop individualized care plans with short- and long-term goals.
Maintain engagement with assigned patients through in-person meetings, text and telephone communication, and community outreach.
Provide in-person support to patients in waiting rooms and during appointments.
Ensure patients have accurate and up-to-date shared care plans.
Connect clients with services and resources that address their comprehensive needs.
Participate in medical team huddles to improve communication among the care team, partner outreach, and housing agencies.
Document patient interactions, care plans, and outcomes clearly and promptly in accordance with program requirements.
Participate in care coordination meetings and internal case conferences with dental and behavioral health departments.
Track patient panels in the electronic Population Health Management System, such as i2i.
Collaborate with patients using caring, non-judgmental interactions and follow organizational guidelines.
Support quality improvement initiatives aligned with the organization’s mission and strategic goals, applicable laws and regulations, and accreditation standards.
Comply with state and federal laws and regulations, including HIPAA, sexual harassment requirements, scope of practice, and OSHA.
Travel between sites when needed for coverage or meetings.
Perform other duties as assigned.