Case Manager- EPS

Base Pay: $23.00 - $33.80 JOB SUMMARY Provide case management services for patients with complex health and social issues.

Including individuals who are unsheltered, have a substance use or mental health diagnosis or are high utilizing Medi-Cal and Medi-Medi beneficiaries.

The Enhanced Patient Services Case Manager will support accessing and linking patients to resources in the community.

The Case Manager is responsible for enrolling appropriate participants, assessing, making appropriate referrals, appointment setting, and monitoring/reporting patients' progress and needs, patient empowerment and utilization review and fieldwork.

The Case Manager will work closely with the patient's medical team, community non-profits, hospitals and health clinics to coordinate access to primary health care.

The Case Manager will also be responsible for following SCHC protocol and practices around billing, documenting case notes, and entering data regarding patients' progress in the required Case Management system.

This position is responsible for working with individuals with complex health and psychosocial needs.

This position is responsible for working with patients in housed and unhoused settings and in a variety of program settings, including Medical Respite.

JOB DUTIES AND RESPONSIBILITIES • Performs a variety of services related to the case management of patients • Reviews daily referrals: meet with clients to obtain program consent, administer required assessments, and review client's care plan, medical follow-up and psychosocial needs.

• Work collaboratively with patient's medical team • Identifies needs of patients and draws from a comprehensive bank of community resources • Follows an assessment protocol to assess the needs of patients • Respect and value the patients in showing sensitivity to issues of diversity, ethnicity, gender, sexual orientation, age and disability • Engages the patient in the development of a service plan tailored to meet the patient's unique needs, circumstances, and preferences as determined through assessment • Assist clients in establishing individualized health goals, identifying potential problems/barriers; provide health education resources.

Provide advocacy for clients and monitor client's progress.

• Coordinate logistics for health goal adherence • Supports patient with creating a continuum of care plan to meet their physical and social needs.

• Educates the patient to make informed choices; maintains client records that include assessment plans, and case notes that are comprehensive and up to date • Coordinate with Community and County Agencies involved with the homeless population • Participates in interdisciplinary treatment team and supports patient's ability to communicate his/her needs effectively • Attend community meetings, as approved by supervisor • Supports patients with transitions of care • Document all clinical support tasks to meet data collection requirements • Parti...