Lead Care Manager (39852)

Position Summary :

Person in this position will be responsible for receiving, reviewing, and processing all incoming Member referrals from the Health Plan of San Joaquin.

The Lead Care Manager will work as part of the Member’s multi-disciplinary care team and will be responsible for coordinating all aspects of Enhanced Care Management services.

This includes but is not limited to; conducting outreach, eligibility verifications, service coordination between Individuals and / or entities, completing authorization requests and providing support to the Member and / or their family with the goal of addressing the clinical and non-clinical needs of high-need Members.

Essential Job Functions include those listed below.

Essential Job Functions :

• Have a strong working knowledge of housing services, supportive services, and community resources;
• Intake and assessment of incoming participants to determine eligibility and prioritization for highest level of risk and need Members;
• Conduct outreach activities throughout the Health Plan of San Joaquin service area including street outreach, engagement, and assessment;
• Develop Individualized care management plans and submit Member Authorization requests to HPSJ;
• Manage a caseload of participants including maintenance of client files and tracking pertinent data;
• Will provide service coordination between Members and or other entities;
• Ensure there is no duplication of services;
• Identify clinical and non-clinical resources for the Member;
• Ensure Members have continuous and integrated care among all service providers;
• Make referrals and conduct follow-ups with medical providers, community-based and social services, including housing;
• Provide support to Members in their treatment by coordinating appointments, transportation, medication review and / or reconciliation, appointment reminders and accompany them, if needed;
• Have open and consistent communication with the Member’s multidisciplinary Team;
• Follow clients through and among services to achieve health stability;
• Provide daily, weekly, and monthly reports as requested;
• Heavy documentation; WestCare’ s Clinical Data System;
• Regular contact with members to ensure there are no gaps in the activities designed to address an individual’s health and social service needs, and swiftly addressing those gaps to ensure progress towards regaining health and function continues;
• Provide all services in linguistically and culturally appropriate manner, including use of interpreters for those with limited English proficiency;
• Embrace and embody the mission, vision, guiding principles, clinical vision, and goals of WestCare Foundation; and
• Perform any other duties as assigned.

Essential Qualifications :

• Two (2) years of Case Management / Direct Outreach experience preferred; and
• Excellent communication skills;
• Bilingual preferred;
• Excellent computer skills;
• Excellent documentation skills;
• Be able to multi-task; and
• Valid driver’s license
• Must maintain and execute confidential information.
• Demonstrated ability to work with diverse communities.
• CPR Certification, First Aid Certification, and an Annual Tuberculosis test

Education :

• Graduation with a two-year degree in Addiction Counseling, Psychology, Social Work, Community and Human Services, Rehabilitation Counseling or a related field is preferred; and
• High School diploma or equivalent is required.

Working Conditions :

• Work is performed in a combination of office and outdoor settings; and
• Travel is required.

Physical Demands :

• Occasional lifting of more than 50 pounds.
• Transportation of clients in company vehicle
• Occasional risk of intensive physical activity with client; and
• Sitting, standing, walking, reaching are performed in the normal course of the position; and
• The normal work routine involves no exposure to blood, body fluids, or tissues, BUT exposure or potential exposure may be required as a condition of employment.
• Appropriate personal protective equipment will be readily available to every employee engaged in Category II tasks;
30+ days ago