Social Work Case Manager

Open Door Community Health Centers•Arcata, CA

1d•$30 - $34•Onsite

About The Position

A Social Work Case Manager (SWCM) at Open Door Community Health Centers provides integrated, supportive, and enabling services to health center patients. The SWCM works with an interdisciplinary care team to support continuity of care and help patients access services and resources for medical, psychological, and socioeconomic needs. The role identifies and addresses non-clinical social determinants of health to promote positive health outcomes and reduce health inequities, with a focus on marginalized and underserved community members with limited access to resources. The position assesses patients’ biopsychosocial needs, develops individualized case-management plans, connects patients with community resources and benefit programs, and supports patients and families in pursuing health and other goals. It manages complex cases across the continuum of care and collaborates with clinic teams and external agencies. The position is largely office-based and requires local and long-distance travel as needed. Compensation is $29.75–$34.43 per hour. Hmong and Spanish speakers who pass a language exam receive a minimum additional $0.75 hourly differential.

Requirements

Bachelor’s degree in a social service or health-related field, or an equivalent combination of education and experience.
Two years of experience in a similar role, or an equivalent combination of education and experience.
Demonstrated experience working with intersectional marginalized populations, including people with mental illness or disabilities, seniors, people experiencing houselessness, and/or patients with substance dependence.
Knowledge of local community resources and agencies providing social services.
Strong interpersonal skills and ability to establish constructive professional relationships in a diverse workforce.
Active listening, motivational interviewing, emotional intelligence, cultural humility, and critical-thinking skills to engage diverse patients and families.
Ability to advocate for patients, encourage independence, and help them develop skills to manage challenges and make healthy decisions.
Knowledge of trauma’s effects on families experiencing poverty, food insecurity, substance-use problems, housing insecurity, and other social determinants of health; familiarity with evidence-based, patient-centered, trauma-informed, and resilience-oriented practices.
Ability to work under pressure with minimal supervision; strong time-management and organizational skills; flexibility to handle multiple cases and competing demands.
Ability to work collaboratively in an interdisciplinary care team and keep the team informed about progress and care-plan changes.
Ability to handle difficult or confrontational situations calmly, consistently, and equitably.
Attention to detail; patience; ability to write comprehensive chart notes and routine correspondence and complete extensive forms and paper applications.
Ability to represent ODCHC effectively in the community and maintain working relationships with coworkers and public, private, and professional groups.
Strong computer skills, particularly with Microsoft Office Suite and/or electronic medical records.
Adherence to the National Association of Social Work Code of Ethics and ODCHC policies and procedures.
Ability to communicate by telephone, video, and/or in person; read documents, computer screens, and forms; remain stationary for extended periods; use a keyboard and view screens for extended periods; lift, carry, or otherwise move up to 25 pounds; travel locally and long-distance as needed; and move around offices and clinics as needed.

Nice To Haves

A master’s degree or related advanced degree.
Experience with eligibility for public benefits such as Medi-Cal, Medicare, Social Security, CalFresh, Unemployment, and State Disability benefits.
Bilingual competency in Spanish or Hmong; speakers who pass a language exam receive a minimum $0.75 hourly differential.

Responsibilities

Assist patients in navigating social determinants of health to provide effective interventions, improve health outcomes, and increase access to resources.
Maintain knowledge of and relationships with community resources, benefit programs, and social service providers; assist with eligibility, referrals, documentation, navigation, education, enrollment, and follow-up.
Assess patients’ biopsychosocial needs, identify barriers and strengths, and develop and implement individualized case-management plans in collaboration with patients and care teams.
Meet regularly with patients and use proactive, flexible, evidence-based approaches to engage patients and families in achieving goals and optimizing health.
Manage complex cases and coordinate services across the continuum of care.
Identify and facilitate referrals to relevant community programs and services, including substance-use, disability, employment, mental health, housing, family, transportation, long-term care, social service, food, financial security, and government programs.
Use de-escalation, crisis intervention, trauma-response, and safety-planning techniques; practice harm reduction, strengths-based approaches, and informed consent.
Participate in and help facilitate peer-support and educational groups as directed.
Coordinate with internal and external programs and agencies to promote interagency collaboration.
Participate in case conferences with primary care teams, behavioral health clinicians, supervisors, and case managers; facilitate consultation with interdisciplinary providers and embedded programs as needed.
Meet department standards for referrals, tracking, and reporting; participate in quality-improvement and risk-management activities.
Participate in program development, planning, implementation, and evaluation.
Monitor systemic barriers and access-to-care issues and communicate recommendations to the supervisor and clinic leadership.
Contribute to an efficient, accessible, productive, high-quality, safe, compassionate, and professional work setting.
Perform other duties and responsibilities assigned by the supervisor.