Behavioral Health Case Manager (Julian, CA - Onsite)

Position Summary :

Under the direct supervision of the BH Case Manager Supervisor and general oversight of the Rural Telehealth Program Manager, the Behavioral Health Case Manager is responsible for providing direct services and coordinating care for behavioral health patients with particular focus on those with complex needs. Specifically, the Case Manager works to ensure patients have access to the care and referral services needed to achieve and maintain optimal functioning. The Case Manager will also serve as the on-site liaison at the Mountain Health Family Medicine clinic for the rural telehealth grant program. The Case Manager is responsible for providing case management and community engagement services to patients engaged in or referred to Behavioral Health Services. The Behavioral Health Case Manager will participate in all-staff meetings, treatment team meetings, conduct presentations, and represent the Rural Telehealth program in internal and external community engagement.

Please note - this is a grant funded position. The grant is due to end September 30, 2028.

Essential Functions of the Job :

• Provides direct services to patients, including case management, referral support, warm handoffs, and psycho-educational groups.
• Conducts a comprehensive assessment of the patients' health and psychosocial needs, including health literacy status and deficits to identify appropriate level of care and create a case management plan in collaboration with family and department staff.
• Begins developing the therapeutic alliance with patients by providing an orientation to the behavioral health department and the services available.
• Identifies and supports patients and families who are eligible for services and in need of case management services. Coordinates patient care with behavioral health provider, Primary Care Physician (PCP), and / or psychiatrist via consultation, collaboration, follow up, and recommendations. Completes warm handoffs for patients identified by PCP as needing behavioral health.
• Collaborates with other SYHealth Departments (e.g. Referrals, Social Services, Health Education, etc.) to facilitate and monitor referral requests and processes to ensure timely receipt of services.
• Closely collaborates with Rural Telehealth Program Manager and clinic staff to support scheduling, initiation, and completion of telehealth visits with behavioral health providers at other sites.
• Assists patients and families in accessing resources and overcoming barriers to care.
• Manages internal and external referrals to the behavioral health department, including follow-up phone calls, sending letters, and communicating with referring staff.
• Educates patients, families, caregivers, and members of the health care delivery team about treatment options, community resources, insurance benefits, psychosocial concerns, case management, etc. so that timely and informed decisions can be made.
• Represents San Ysidro Health and the Behavioral Health Department in the community to create and maintain partnerships with other programs and to improve referral outcomes and quality of care for patients.
• Maintains timely, complete, and accurate records with detailed assessment results, action plan, and progress notes. Clearly documents plans discussed with the patient, family, behavioral health clinicians, PCPs, etc. in the electronic health record system to ensure that communication is available to all team members.
• Assists in the preparation of monthly narrative and statistical reports covering progress toward meeting process objectives and / or as required by department and organizational leadership.
• Works closely with Rural Telehealth Program Data Analyst in monitoring and tracking program deliverables and outcomes.
• Provides coordination and collaboration with community agencies to identify patients who are eligible for behavioral health services and facilitates referral process.
• Maintains productivity of patient visits in accordance with clinic / program guidelines.
• Complies with established departmental and health center policies and procedures, objectives, quality assurance program, safety, environmental and infection control standards.
• Performs other related activities as required, assigned and / or requested.

Additional Duties and Responsibilities :

Job Requirements

Education Required :

Bachelor's degree from a four-year college or university in psychology, social work, or related field - OR - High School Diploma with 2 years of behavioral health case management experience.

Experience and Required Skills :

One year experience providing case management services to a wide range of patient populations including adults, youth, and families.

Computer literacy required (i.e. proficient in word processing software; Microsoft office; Excel spreadsheets); Electronic Medical Records software.

Verbal and Written Skills Required to Perform the Job :

Bilingual Spanish / English required. Must possess excellent customer services, communication, and documentation skills, with the ability to work cooperatively with other departments within a large community health center and satellite clinics. Must work well in a multi-disciplinary setting.

Equipment Used :

Computers, phones, vehicles, copy machines and fax machines etc.

Working Conditions and Physical Requirements :

General office environment. Prolonged sitting. Occasional standing, walking, lifting, pushing, pulling up to 10 lbs. Local travel around San Diego County for meetings, trainings, community engagement, and coverage may be required - must have reliable transportation.

Universal Requirements :

Pre-employment requirements include I-9, physical, positive background and reference check results, complete application, new hire orientation, pre-employment PPDs.

About Us San Ysidro Health is a Federally Qualified Health Care organization committed to providing high quality, compassionate, accessible and affordable healthcare services for the entire family. The organization was founded by seven women in search of medical services for their families and community. Almost 50 years later, San Ysidro Health now provides innovative care to over 108,000 patients through a vast and integrated network of 47 program sites across the county. San Ysidro Health could not serve our patients without the dedication of our passionate and hardworking employees. Apply today and become a part of our mission-driven team! San Ysidro Health has a long-standing commitment to equal employment opportunity for all applicants for employment. Employment decisions including, but not limited to, those such as employee selection, performance evaluation, administration of benefits, working conditions, employee programs, transfers, position changes, training, disciplinary action, compensation, and separations are made without regard to race, color, religion (including religious dress and grooming), creed, national origin, nationality, citizenship status, domestic partnership status, ancestry, gender, affectional or sexual orientation, gender identity or expression, marital status, civil union status, family status, age, mental or physical disability (including AIDS or HIV-related status), atypical heredity cellular or blood trait of an individual, genetic information or refusal to submit to a genetic test or make available the results of a genetic test, military status, veteran status, or any other characteristic protected by applicable federal, state, or local laws.