Case Manager- Bilingual

Sonoma Community Action Network•Santa Rosa, CA

2h•$22 - $26

About The Position

The Community Health Worker/Case Manager is a frontline, client-facing role within Sonoma CAN’s Thriving Families Department, with a strong emphasis on CalAIM Enhanced Care Management (ECM) principles, such as a person-centered, high-touch approach to address social drivers of health. This position serves as the first point of contact for individuals and families seeking services at Sonoma CAN and is responsible for intakes, assessments, triage, and ongoing case management. The CHW/Case Manager works closely with families to identify strengths, assess needs, reduce barriers to care, and support progress toward stability using trauma-informed, culturally responsive, and motivational interviewing approaches. This role requires strong documentation skills, including the ability to complete timely, accurate case notes, and collaboration across internal programs and external community partners.

Requirements

Excellent bilingual language skills, in speaking, reading, and writing (English/Spanish)
Excellent interpersonal communication skills and the ability to build strong relationships.
Develops and maintains a positive team working environment with staff.
Detailed oriented with strong organization and time management skills.
Ability to to express and implement basic problem solving techniques.
Cultural humility - ability to interact productively with persons of all economic, ethnic, linguistic and cultural backgrounds
Intermediate proficiency with Word processing and Google Docs.
Intermediate proficiency with spreadsheets, preferably Google Sheets.
Ability to work in a fast paced, dynamic environment with minimal supervision and multiple deadlines.
Uphold and act in alignment with the Mission, Vision, and Values of the agency as stated above.
Valid California Driver's License and a properly insured vehicle for use on the job
Prior to beginning work, must be able to pass a criminal record background check
High School Diploma or equivalent
Minimum of 2 years of experience in direct service work with individuals and/or families (e.g., community health, case management, social services, behavioral health, housing, or related fields)
Experience working with low-income or marginalized communities

Nice To Haves

AA degree or higher in social services, human services, psychology, public health, or related field
Experience working within CalAIM, ECM, or Medi-Cal–adjacent systems
Prior experience conducting intakes, assessments, and ongoing case management
3+ years’ experience in the nonprofit sector.

Responsibilities

Serve as the primary intake and screening point for individuals and families seeking services at Sonoma CAN.
Conduct initial and ongoing strengths-based, trauma-informed assessments via phone, in person, or virtual platforms.
Utilize motivational interviewing techniques to engage clients, support goal-setting, and encourage self-efficacy.
Partner with individuals and families to explore needs, strengths, and goals, and connect them to Sonoma CAN programs, CalAIM-related supports, and appropriate community resources.
Provide short- and medium-term case management services to individuals and families with complex needs.
Develop individualized service plans in partnership with clients, aligned with CalAIM and whole-family principles designed to meet the needs of children and their caregivers.
Coordinate referrals and warm handoffs to internal programs and external service providers, including; healthcare, behavioral health, workforce, and family supports.
Provide follow-up, advocacy, and problem-solving support to reduce barriers to care.
Complete accurate, timely documentation of all client interactions, including structured PIRP (Problem, Intervention, Response, Plan) progress notes and required assessment tools.
Maintain up-to-date client records in agency databases (e.g., empowOR, ChildPlus) in compliance with program, funder, and CalAIM documentation standards.
Collect and enter data to support billing, reporting, outcomes tracking, and continuous quality improvement.
Participate in outreach activities, tabling events, and community presentations to connect families to services.
Build and maintain collaborative relationships with community-based organizations, healthcare partners, and referral sources.
Educate clients and community members about Sonoma CAN programs and available resources.
Serve as a responder during community-wide emergencies or crises, providing intake, assessment, and resource navigation support as needed.
Collaborate closely with supervisors, program coordinators, and interdisciplinary teams to ensure coordinated care.
Participate in team meetings, trainings, and professional development opportunities, including CalAIM, trauma-informed care, and equity-focused practices.

Benefits

Medical insurance through Kaiser or Sutter is 80-95% paid by the employer for employee premiums, plus 50% paid by the employer for dependent coverage
Elective dental, vision insurance, FSA, and Accident insurance.
Employer-paid $10k of life insurance with expandable options
Employer-paid Long-term Disability Insurance
401(K) plan with a 2% contribution and an additional 1% matched contribution after one year of service
Employee assistance program, CalPerks
3 weeks vacation (4 hours accrued per pay period) based on full-time work increases at 5 years of service
96 hours of sick time per year (4 hours accrued per pay period) based on full-time work
1 floating personal day
16 paid holidays