PACE Care Manager I

Institute on Aging • San Francisco, CA

1d • $35 - $42

About The Position

IOA is on the forefront of revolutionary healthcare models, reshaping the way people can age in place. Our innovative models transform lives, enhance communities, and save healthcare systems millions of dollars. Rather than focusing on archaic outdated design, we strive to consistently question the “status-quo” and create new and more innovative ways to help aging adults and adults with disabilities maintain their quality of life. With over 23 programs, we offer multiple ways to aid seniors maintain their health, well-being, independence and participation in the community, fulfilling our mission. PRIMARY RESPONSIBILITY: The PACE Care Manager I provides case management and care coordination support to a panel of assigned participants enrolled in the On Lok Program of All-Inclusive Care for the Elderly (PACE) at IOA. The Care Manager I works closely with an assigned Medical Social Worker and other members of the participant’s Interdisciplinary Team (IDT). SPECIFIC RESPONSIBILITIES: Establishes and maintains a care management relationship with clients and their formal and informal support systems, as appropriate, offering respect, dignity and support. Meets with clients as needed and as directed, and collaborates with the Medical Social Worker to ensure that participants’ biopsychosocial needs are being monitored and met. Identifies participant needs, advocates for, coordinates, and follows-up on services by making appropriate and timely referrals to both internal and external services. Assists with transitions of care. Partners with other IDT members to ensure that necessary services are arranged and in place. Coordinates the required documentation and notification for Participants who travel outside of the service area. Facilitates discharge to other programs and to the community. Documents via progress notes all case management activity according to departmental guidelines and standards. Maintains required paperwork. Appropriately identifies and communicates participant concerns and needs to the assigned Medical Social Worker and/or other members of the IDT. Attends and actively participates in IDT and program meetings, activities and problem-solving endeavors; contributes to open lines of communication within the team. Participates in and promotes ongoing efforts toward continuous quality improvement. Utilizes supervision appropriately; maintains open lines of communication and updates on caseload activity. Actively incorporates the ethical standards of the National Association of Social Workers into all aspects of interactions with others. Understands and applies the regulatory and procedural requirements of PACE and associated licensing, as well as the policies and procedures of IOA. Stays up-to-date on case management principles, the field of gerontology, family and community systems and other areas relevant to the client population. All other reasonably related responsibilities as assigned.

Requirements

• BA or BS in Social Work or a closely related field required.
• At least one year of professional experience working with a frail older adult population.
• At least one year of experience in a case management role, preferably working with older adults and/or functionally impaired adults.
• Bilingual in English/Cantonese or English/Spanish required.

Nice To Haves

• Experience with and understanding of the medical and psychosocial problems of functionally impaired adults and the frail elderly.
• Exceptional communication and presentation skills relating to the frail elderly, functionally impaired adults, their support systems, and teams of health professionals.
• Demonstrates case management skills and experience in the community health care delivery system.
• Detail oriented with good problem-solving skills and the ability to prioritize multiple tasks.
• Computer literacy preferred.

Responsibilities

• Establishes and maintains a care management relationship with clients and their formal and informal support systems, as appropriate, offering respect, dignity and support.
• Meets with clients as needed and as directed, and collaborates with the Medical Social Worker to ensure that participants’ biopsychosocial needs are being monitored and met.
• Identifies participant needs, advocates for, coordinates, and follows-up on services by making appropriate and timely referrals to both internal and external services.
• Assists with transitions of care.
• Partners with other IDT members to ensure that necessary services are arranged and in place.
• Coordinates the required documentation and notification for Participants who travel outside of the service area.
• Facilitates discharge to other programs and to the community.
• Documents via progress notes all case management activity according to departmental guidelines and standards.
• Maintains required paperwork.
• Appropriately identifies and communicates participant concerns and needs to the assigned Medical Social Worker and/or other members of the IDT.
• Attends and actively participates in IDT and program meetings, activities and problem-solving endeavors; contributes to open lines of communication within the team.
• Participates in and promotes ongoing efforts toward continuous quality improvement.
• Utilizes supervision appropriately; maintains open lines of communication and updates on caseload activity.
• Actively incorporates the ethical standards of the National Association of Social Workers into all aspects of interactions with others.
• Understands and applies the regulatory and procedural requirements of PACE and associated licensing, as well as the policies and procedures of IOA.
• Stays up-to-date on case management principles, the field of gerontology, family and community systems and other areas relevant to the client population.
• All other reasonably related responsibilities as assigned.

Benefits

• From competitive salaries to investment and retirement opportunities, we offer our employees first-rate benefits.
• Coupled with outstanding health coverage, robust wellness programs, and additional perks, we make a rewarding career even more rewarding.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Number of Employees: 101-250 employees