Case Manager III

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 service
• Proactively 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 review
• Actively 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 care
• Provide and facilitate referrals for internal and external resources, and collaborate with the patient to complete required applications, forms, or releases of information
• Maintain a patient caseload in accordance with LifeLong standards for the specific population served or site requirements
• Utilize data registries and reports to manage caseload, meet program requirements, maintain grant deliverables, and promote high quality care
• Provide 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)
• Afford patients with accessing and retaining public benefits and insurance (e.g. MediCal, SSI/SSDI, CalFresh, General Assistance), and affordable/subsidized housing
• Respectfully and routinely communicate with patients, their care team members, external partners, and identified social supports
• Maintain 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 services
• Provide 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 System
• Assess 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 care
• Cofacilitate patient groups
• Provide intensive case management to a caseload size in accordance with site or program standards focusing on a subset of the highest acuity patients
• Lead crisis intervention response, de-escalation procedures, notification of the local mental health department and/or crisis response team, and follow-up care
• Provide and document billable services to eligible populations that result in revenue generation for LifeLong
• Advocate 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 population
• Document patient contacts/services in required data systems (EHR, HMIS etc.) according to LifeLong policy

Qualifications

Required:

• Bachelor’s degree in a related field (e.g., social work, public health, nursing, psychology)
• Minimum of 5 years of relevant experience in case management, healthcare, or social services
• Experience working with individuals with complex health and social service needs
• Knowledge of Medicaid, Medicare, and other public benefit programs
• Ability to work independently and as part of a team
• Strong communication and interpersonal skills
• Proficiency in Microsoft Office Suite

Preferred:

• Master’s degree in a related field
• Experience with Coordinated Entry System
• Experience with housing navigation services
• Experience with crisis intervention and de-escalation techniques
• Experience with data management and reporting