Case Manager Health Homes Program

Job Description

Position Purpose:

Principle Responsibilities:

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.

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.

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.

Advocates on behalf of members with healthcare professionals, utilizing motivational interviewing, trauma-informed care, and harm-reduction approaches.

Coordinates with hospital staff on discharge plans, monitors treatment adherence (including medication), and provides health promotion and self-management training.

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.

Participates in agency and community meetings related to the needs of patients and issues related to case management diseases.

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.

Performs other duties as assigned.

Requirements:

AA or bachelor’s degree in Social Work, sociology or related field experience with at least 1-year experience as care coordinator, community health worker or similar responsibilities.

High School Diploma or GED with at least 2 years’ experience as care coordinator, housing navigation, community health worker or similar responsibilities. (Certified Community Health Worker strongly recommended)

Medical Assistant or LVN with at least 1-year experience in case management is preferred.

Experience working with individuals who have multiple chronic conditions, ER visits or frequent in-patients’ admissions or experiencing homelessness.

Electronic Health Record experience and/ Data entry skills required.

Proficient in utilizing Microsoft Word, Excel and Power Point.

Good communication and customer service skills.

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

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.