Social Work Case Manager

Innovative Integrated Health Inc; Fresno (CA); On-site; USD 58,000 - 68,000; Full time

Benefits offered by this job

401(k)

Dental insurance

Employee assistance program

Flexible spending account

Health insurance

Health savings account

Life insurance

Paid sick time

Paid time off

Referral program

Retirement plan

Vision insurance

Job summary

Innovative Integrated Health Inc seeks a Social Work Case Manager to provide direct case management services to PACE program participants in Fresno, CA. You will work with an interdisciplinary team to support frail elderly while coordinating services at home.

You will maintain records, advocate for participants, and liaise with agencies such as Social Security, Medicaid, and aging services. CPR with First Aid certification and a bachelor’s in social work are required.

Qualifications

• Bachelor’s degree in social work or related field required.
• CPR with First Aid certification.
• Experience with frail elderly population.
• Knowledge of Medicare/Medicaid financing and aging networks.

Responsibilities

• Follow directives from IDT and meet with family members and other community members/agencies as needed.
• Coordinate ongoing family meetings and case management.
• Coordinate discharge planning for participants returning home from hospital or nursing facility.
• Maintain current case management records and documentation of services.
• Act as liaison between participants and external agencies (Dept. of Aging, SSA, Medicaid).
• Participate in participant-related meetings with external agencies and conferences.
• Assist with government program financial eligibility applications and housing resources.

Skills

Interdisciplinary teamwork

Excellent communication skills

Computer skills

Medicare/Medicaid knowledge

English language proficiency

Education

Bachelor’s degree in social work or related field

Tools

CPR and First Aid certification

Job description

Who We ArePACE by IIH is empowering senior participants to age at home with dignity through personalized, comprehensive care plans that deliver high-quality health and human services along with strong community support. Through an interdisciplinary and participant-centered model of care, PACE by IIH is committed to improving quality of life, promoting independence, and providing compassionate support tailored to the unique needs of each participant. Our team works collaboratively to deliver innovative, community-based healthcare solutions that allow seniors to remain safely and comfortably in their homes while receiving the care and services they need to thrive.Benefits401(k)Dental insuranceEmployee assistance programEmployee discountFlexible spending accountHealth insuranceHealth savings accountLife insurancePaid sick timePaid time offReferral programRetirement planVision insuranceJob SummaryThe Social Work Case Manager is responsible for providing direct social work case management services to participants.Essential Job FunctionsDuties include but are not limited to:Follow social work directives from interdisciplinary team (IDT) and meet with family members and other community members/agencies as needed.Coordinate ongoing family meetings, as needed.Provide ongoing case management and advocacy as required.In conjunction with the interdisciplinary team, coordinate discharge planning for participants returning home from hospital or nursing facility.Maintain current, written case management records, including ongoing documentation of services provided, and participants expressed wishes.Act as liaison between the participant and other agencies such as Department of Aging, Social Security Administration, Medicaid, etc.Participate in participant-related meetings with external agencies and conferences in the community as needed.Assist with ongoing government program financial eligibility applications for participants, including recertification as needed.Identify housing resources for participants offered by the community/county. Assist participants with housing resources such as eligibility forms, applications, and navigating various housing options.Conduct home visits, as needed.Assist in connecting with hard-to-reach participants.Maintain confidentiality of participant information.Attend and participate in staff meetings, in-services, projects, and committees as assigned.Adhere to and support the center’s practices, procedures, and policies including assigned break times and attendance.Accept assigned duties in a cooperative manner; and perform all other related duties as assigned.Be flexible in schedule of hours worked.May require use of personal vehicle.Knowledge, Skills, and AbilitiesInterest in the risk-based long-term care program to serve frail elderly in a community-based setting.Experience and thorough knowledge of social service principles and practices.Knowledge of psychosocial, behavioral, and family needs of the elderly population.Knowledge of financing mechanisms such as Medicare, Medicaid, and Prospective Payment Systems.Knowledge of the local and social service delivery systems and aging network.Proven ability to work in an interdisciplinary team.Ability to work effectively and harmoniously with the staff, the elderly, and providers of services, public, and private agencies.Energetic, dependable, resourceful, and flexible.Effective oral and written communication skills.Computer skills required.Working Conditions and Physical DemandsThe working conditions and physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.Ability to access all areas of the center throughout the workday.Ability to lift up to 35 pounds occasionally, 15 pounds frequently, and 7 pounds constantly; required to obtain assistance of another qualified employee when attempting to lift or transfer objects over 25 pounds.Requires constant hand grasp and finger dexterity; frequent sitting, standing, walking and repetitive leg and arm movements, occasional bending, reaching forward and overhead; squatting and kneeling.Ability to communicate verbally with an excellent comprehension of the English language.Work is generally performed in an indoor, well-lighted, well-ventilated, heated, and air-conditioned environment.ExperiencePreferred one (1) year of documented experience in working with a frail or elderly population required.Prefer experience in a community-based setting or geriatric program.Education and CertificationBachelor’s degree in social work or related field required.CPR with First Aid certification.Is medically cleared for communicable diseases and has all immunizations up-to-date before engaging in direct participant contact.Core ValuesCARE is central to what we do, prioritizing the well-being, dignity, and independence of our senior participants.COMPASSION in every interaction, ensuring kindness, empathy, and understanding guide our care.CULTURE that reflects the diverse backgrounds of those we serve and fosters a workplace where every team member feels supported, valued, and empowered to grow.COMMUNITY that fosters connection, belonging, and support for participants and their families.COMMITMENT to quality improvement, innovation, and delivering healthier outcomes.We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.