Lead Case Manager

Job Description

Job Description

Position Purpose: Join our team as an Enhanced Care Management (ECM) Case Manager and make a difference in the lives of our community's most vulnerable populations. As an ECM Case Manager, you'll provide invaluable case management services to eligible patients, including high service utilizers, individuals and families experiencing homelessness, adults with serious mental illness or substance use disorders, and individuals transitioning from incarceration. Our program's mission is to deliver comprehensive care that improves health outcomes for those who need it most. If you're passionate about making a positive impact and empowering individuals to lead healthier lives, apply now to be part of our dedicated team.

Principle Responsibilities:

1. Collaborates with providers, managed care plans, the Housing Navigation Team, and community homeless service providers to offer enhanced care coordination for eligible patients and/or entities, ensuring a seamless experience and preventing duplication of services.
2. Conducts comprehensive case management services, including intake and assessment, development of a comprehensive care plan, implementation of the care plan, subspecialty referrals, monitoring, and follow-up.
3. Provide comprehensive assessments an intervention in the field including encampments, board and cares, hospitals and patient’s residents.
4. Connects members to other social services/support services and provides appropriate referrals for subspecialty care (e.g., ophthalmology, behavioral health, podiatry, nutrition, health education, etc.), transportation, food, and housing. Accompanies members to office visits as needed.
5. Advocates on behalf of members with healthcare professionals, utilizing motivational interviewing, trauma-informed care, and harm-reduction approaches.
6. Coordinates with hospital staff on discharge plans, monitors treatment adherence (including medication), and provides health promotion and self-management training.
7. Collects and enters necessary data for reporting purposes, completing and submitting monthly project activity and other reports as assigned for submission to the funding source.
8. Participates in agency and community meetings related to the needs of patients and issues related to case management diseases.
9. Participates in weekly case conferences with PCP's clinical supervisor and peers to assist in problem-solving related to clients and ensure that professional guidance and high-quality case management services are provided.
10. Minimum standards include carrying case load of 50, close all encounters daily, average 7.0 encounters per day and 3.0 touch points per patient per month.
11. Adhere to all organizational safety policies, procedures, and regulatory requirements to ensure a safe environment for patients, staff, and visitors.
12. Participate in required safety and compliance trainings and apply learned practices in daily work activities.
13. Identify, report, and help mitigate unsafe conditions, incidents, or hazards in the workplace.
14. Use equipment, tools, and supplies safely and responsibly in accordance with organizational and regulatory standards.
15. Maintain awareness of infection control, occupational health, and emergency preparedness procedures appropriate to the role.

1. Participate in JWCH’s customer service training called AIDET on an annual basis.
   1. Demonstrate an understanding of AIDET (Acknowledge, Introduce, Duration, Explanation, and Thank You) to apply in patient encounters or team discussions.
   2. Utilize the AIDET communication framework to communicate with patients and team members in a manner that reduces patient anxiety, increases patient compliance, and improves clinical outcomes.
2. Performs other duties as assigned.

Requirements:

1. Bachelor’s degree in Social Work, sociology or related field experience with at least 1-year experience as case manager, community health worker or similar responsibilities or

a. AA degree in related field and 2 years’ experience is Case Management or

b. Medical Assistant with at least 2-years’ experience in Case Management.

2. In addition to above must have documented experience working with individuals who have multiple chronic conditions, substance use disorders, mental health issues, ER visits or frequent in-patients’ admissions or experiencing homelessness.

3. Also Electronic Health Record experience and/ Data entry skills required.

4. Proficient in utilizing Microsoft Word, Excel and Power Point.

5. Good communication and customer service skills.

6. Strong desire to work as part of multi-disciplinary team or care coordinators, LCSW, RN’s, LVN’s, MSW, PCP’s and MAs.

7. Must have current California Driver’s License, proof of auto insurance and reliable transportation.

8. Bilingual (English/Spanish) ability strongly preferred.

*All JWCH, Wesley Health Centers workforce members are recommended to be fully vaccinated against COVID-19.

Employee Benefits:

At JWCH Institute, Inc., we're committed to ensuring our team members are well taken care of. In addition to competitive salaries, employees working 30 hours per week or more receive a monthly allowance that applies towards medical, dental, and vision premiums. But wait, there's more! Our benefits package includes sick leave, vacation time, 13 paid holidays, a 401(k) Safe Harbor Profit Sharing plan, mileage reimbursement, short-term and long-term disability plans, life insurance policies, employee parking, and so much more! Join us and discover the wealth of perks waiting for you!

JWCH Institute, Inc + Wesley Health Centers is an Equal Opportunity Employer.