Case Manager, Medical

Role Summary

The Medical Case Manager (CMC) at SNAHC provides comprehensive case management and care coordination for patients with complex physical, behavioral, dental, and social needs. The role involves coordinating referrals, developing care plans, and collaborating with various stakeholders to ensure seamless service delivery.

Essential Functions

• Coordinate referrals to appropriate programs based on eligibility criteria, patient needs, and provider assignment.
• Affirmatively assist with durable medical equipment (DME) referrals for the medical department.
• Maintain productivity goals by ensuring weekly targets are met.
• Assess patients' health status, regional resource utilization, and barriers to care to develop individualized care plans with short- and long-term goals.
• Engage with assigned patients through in-person meetings, text/telephone communication, and community outreach.
• Support patients in waiting rooms and during appointments by providing in-person support.
• Ensure all patients have accurate and up-to-date shared care plans.
• Connect clients to a variety of services and resources to address their comprehensive needs.
• Participate in medical team huddles to enhance communication between the care team, partner outreach, and housing agencies.
• Maintain clear and timely documentation of all patient interactions, care plans, and outcomes in accordance with program requirements.
• Collaborate with patients to follow organizational guidelines through non-judgmental and caring interactions.
• Support quality improvement initiatives in accordance with the organization's mission and strategic goals, federal and state laws and regulations, and accreditation standards.
• Comply with all state and federal laws and regulations, including HIPAA, sexual harassment, scope of practice, OSHA, etc.
• May be required to travel between sites for coverage and/or meetings.

Skills and Abilities

• Excellent computer skills, preferably with Windows, including Microsoft Office Suite.
• Excellent telephone and communication skills.
• Strong organizational, writing, and verbal skills.
• Ability to work independently, set priorities, and work well under pressure.
• High degree of confidentiality.
• Superior professionalism when dealing with patients, subordinates, colleagues, community members, and vendors.
• Ability to collaborate and convene across sectors and organizational levels.

Competencies

• Communication and Relationships
• Initiative
• Planning and Organizing
• Safety
• Teamwork
• Program Specific Workflows