Case Manager III

LifeLong Medical Care; Oakland (CA); On-site; USD 65,000 - 90,000; Full time

Job summary

LifeLong Medical Care is seeking a Case Manager III to support patients with complex health and social needs. The role includes outreach, care planning, and housing navigation, with field visits to homes, clinics, and community sites.

The CM III leads Enhanced Case Management and coordinates both internal and external referrals. Candidates should have strong case management experience, knowledge of behavioral health, and the ability to work with diverse populations.

Qualifications

• Experience in community-based health care or social work settings.
• Knowledge of behavioral health service systems and evidence-based practices.
• Ability to perform case management and harm reduction.

Responsibilities

• Outreach to patients at LifeLong, community and residential sites.
• Develop and implement patient-centered care plans with caregivers.
• Coordinate referrals and assist with applications for services and housing.
• Maintain caseloads and document in required data systems.
• Lead crisis intervention and de-escalation as needed.

Education

High School diploma or GED

Master’s degree in social work

Associate Social Worker registration (California Board of Behavioral Sciences)

Tools

EHR/HMIS systems

Microsoft Office (Word/Excel/Outlook)

Job description

POSITION SUMMARY:The Case Manager III (CM III), a key member of the primary care interdisciplinary team, provides services for patients with complex care needs. This position conducts patient outreach, engagement and psychosocial service assessment, assists in developing a patient-centered care plan, is the lead implementer of Enhanced Case Management (ECM) and coordinates service referrals and delivery. The case manager meets clients in home, clinic, or community as appropriate or required by the specific program/site. The CM III provides services to specific populations that have multiple complex health and social services needs and often provides care outside of a traditional health center setting, such as home visits, hospitals, supportive housing sites, encampments and shelters. In addition, they provide comprehensive housing navigation support to clientsThis position is represented by SEIU-UHW. Salaries and benefits are set by a collective bargaining agreement (CBA), and an employee in this position must remain a member in good standing of SEIU-UHW, as defined in the CBA.JOB DUTIES:Outreach, via telephone and in person at LifeLong, community and residential sites, to patients who meet case management program eligibility criteria or are prioritized by LifeLong for this serviceProactively meet and engage with patients to build effective relationships and assess strengths and needs through use of standard intake, screening tools, and health, and social services records reviewActively involve patients and caregivers, as appropriate, in designing and delivering services, including development of care plans, assuring alignment with patients’ values and expressed goals of careProvide and facilitate referrals for internal and external resources, and collaborate with the patient to complete required applications, forms, or releases of informationMaintain a patient caseload in accordance with LifeLong standards for the specific population served or site requirementsUtilize data registries and reports to manage caseload, meet program requirements, maintain grant deliverables, and promote high quality careProvide health education and training to patients, including but not limited to, harm reduction and disease risk-mitigation strategies that empower patients to manage their own health and wellness (e.g. overdose prevention, mitigating spread of communicable diseases)Assist patients with accessing and retaining public benefits and insurance (e.g. MediCal, SSI/SSDI, CalFresh, General Assistance), and affordable/subsidized housingRespectfully and routinely communicate with patients, their care team members, external partners, and identified social supportsMaintain knowledge of patients’ medical/behavioral health treatment plans and facilitate utilization of services by providing resources such as accompaniment, transportation, in-home care, reminder calls etc.Participate in team meetings to coordinate care, support patient goals, and reducing barriers to accessing servicesProvide case management services to patients with multiple complex acute or chronic medical or behavioral health conditions (e.g. HIV/AIDS, Hep C, congestive heart failure, severe diabetes, severe hypertension, psychosis, pregnancy, and homelessness)Provide general housing case management services that includes document readiness, housing problem solving, and assessments for Coordinated Entry SystemAssess patients to identify cognitive and/or behavioral health needs and provide brief interventions and short-term support using standardized tools and effective approaches for patient careCo-facilitate patient groupsProvide intensive case management to a caseload size in accordance with site or program standards focusing on a subset of the highest acuity patientsProvide specialized housing navigation services to patients who are matched to a housing resource through Coordinated Entry SystemLead crisis intervention response, de-escalation procedures, notification of the local mental health department and/or crisis response team, and follow-up careProvide and document billable services to eligible populations that result in revenue generation for LifeLongAdvocate on behalf of patients to get their needs met and/or support patients to learn advocacy strategies for themselves.Keep current on community resources and social service supports to effectively serve the target populationDocument patient contacts/services in required data systems (EHR, HMIS etc.) according to LifeLong policySpecific activities may vary depending on the requirements of the program and funderPromote diversity, equity, inclusion, and belonging in support of patients and staffRepresent LifeLong positively in the community and advocate on behalf of underserved populationsJOB QUALIFICATIONS:Commitment to working directly with low-income persons from diverse backgrounds in a culturally responsive mannerCommitment to harm reduction, recovery, housing first, age-friendly and patient centered careStrong organizational, administrative and problem-solving skills, and ability to be flexible and adaptive to change while maintaining a positive attitudeExcellent interpersonal, verbal, and written skillsAbility to prioritize tasks, work under pressure, and complete assignments in a timely mannerAbility to seek direction/approval on essential matters, yet work independently, using professional judgment and diplomacyWorks well in a team-oriented environmentConducts oneself in external settings in a way that reflects positively on your employerAbility to be creative, mature, proactive, and committed to continual learning and improvement in professional settingsJob Requirements:High School diploma or GEDAt least three (3) years of progressively responsible work or volunteer experience in a community-based health care or social work setting or at least one (1) year of experience as a Case Manager II or equivalent position or registration or certification as a Certified Alcohol and Drug Counselor by one of the two certifying bodies in CaliforniaOr A Master’s degree in social work and registration as an Associate Social Worker with the California Board of Behavioral Sciences can be substituted for the 2 years of experience requirement.Working knowledge of the local behavioral health service system.Familiarity with evidence-based practices for behavioral health disorders.Experience in clinical case management and harm reduction.Proficient skills using Microsoft Office applications like Word, Excel, and Outlook, as well as the ability to work in and/or manage databasesAccess to reliable transportation with current license and insuranceJob Preferences:Lived experience relative to working with people experiencing homelessness (e.g. formerly homeless, social or behavioral health services consumer, criminal justice system involvement, foster care involvement, close family-member of someone with these experiences).