Community Services Case Manager

St Mary's Center•Emeryville, CA

3d•Onsite

About The Position

St. Mary’s Center is a community-based organization serving older adults, preschool families, and individuals experiencing homelessness in Oakland and surrounding Alameda County. Its Community Outreach & Services (COS) Department helps seniors remain safely housed and socially connected, reduce isolation, improve wellness, and access community-based supports. The Community Services Case Manager provides comprehensive AAA-aligned case management services to older adults and adults with disabilities participating in St. Mary’s Center programs. The role supports participants in maintaining independence, improving health and social outcomes, and remaining safely housed through coordinated care planning, advocacy, benefits assistance, and connection to supportive services. The Case Manager maintains an active caseload of approximately 30 participants and delivers individualized, trauma-informed, culturally responsive services through assessments, home and office visits, phone outreach, care coordination, group support, and collaboration with community providers and multidisciplinary teams. The position also supports Medi-Cal Administrative Activities (MAA/CMAA) through eligible outreach, referral coordination, benefits navigation, health-related case management, and documentation intended to improve access to medical, behavioral health, and supportive services. It is full-time, non-exempt, Monday through Friday from 8:30 AM to 5:00 PM, pays $32.80 per hour, and reports to the Community Services Supervisor. Work takes place in community-based settings throughout Alameda County.

Requirements

Strong communication and interpersonal skills.
Ability to work effectively with older adults and vulnerable populations.
Knowledge of community resources, benefits systems, and supportive housing.
Familiarity with Medi-Cal, SSI, IHSS, and CalFresh.
Knowledge of trauma-informed care, motivational interviewing, and harm reduction.
Understanding of elder abuse prevention and mandated reporting.
Strong organizational and documentation skills.
Associate or bachelor's degree in human services, psychology, sociology, or a related field, or three years of experience in a related field.
California Driver's License.
Ability to sit, stand, walk, bend, and communicate effectively throughout the workday.
Ability to travel to participant homes and community sites.
Ability to occasionally lift and/or move up to 20 pounds.
Ability to use computers, phones, tablets, and related technology for documentation and communication.

Nice To Haves

Minimum of 2 years of experience working with older adults, vulnerable populations, or community-based programs preferred.

Responsibilities

Maintain an active caseload of 30 seniors and adults with disabilities enrolled in AAA and Community Services programs.
Conduct comprehensive biopsychosocial assessments to identify participant strengths, risks, barriers, and service needs.
Develop, implement, monitor, and update individualized case plans.
Coordinate transportation, meals, medical and behavioral health services, medication support, shopping assistance, housing resources, IHSS, benefits advocacy, legal services, social activities, and other supports.
Assist participants with Medi-Cal, SSI, CalFresh, IHSS, and related applications and renewals.
Provide health-related care coordination and referrals.
Conduct home visits, wellness checks, and follow-up contacts.
Provide crisis intervention and de-escalation support within scope of practice.
Identify and report suspected elder abuse or neglect.
Support transitions to higher levels of care when appropriate.
Facilitate participant engagement in Community Center programming.
Conduct Medi-Cal outreach and education activities.
Assist participants in accessing medically necessary services.
Coordinate communication between providers, social services, and caregivers.
Maintain accurate documentation and reporting aligned with county and state requirements for eligible MAA/CMAA activities.
Participate in data collection and service tracking activities that support reimbursement and reporting efforts.
Collaborate with Housing Services, Behavioral Health, Community Center staff, and leadership.
Partner with Alameda County agencies, hospitals, clinics, managed care plans, and community-based organizations.
Participate in interdisciplinary case conferencing and care coordination meetings.
Engage caregivers and family members when appropriate.
Represent St. Mary’s Center at community meetings and trainings.
Maintain accurate and timely documentation in agency and County systems.
Complete assessments, progress notes, case plans, referrals, and discharge summaries.
Maintain compliance with HIPAA, state, county, city, and agency standards.
Track units of service, outcomes, and referrals.
Complete 20 hours of Community Health Worker training and 6 hours of continuing education annually.
Participate in required quality assurance activities and trainings.
Promote COS programs through outreach events, presentations, and community engagement activities.
Assist with congregate meal services, workshops, and cultural programming.
Participate in emergency preparedness and emergency response activities.
Collect participant feedback and support program evaluation efforts.
Promote a safe, respectful, and inclusive environment; support the mission and values of St. Mary’s Center; maintain professionalism and confidentiality; and follow agency policies and procedures.