Case Manager

Job Description

Job Description

Location : Skid-Row Downtown Los Angeles (CA)

JWCH Mission Statement : The Mission of JWCH Institute is to improve the health status and well-being of under-served segments of the population of Los Angeles Area through the direct provision or coordination of health care, health education, services, and research.

Position Purpose : The Case Manager provides comprehensive case management services to eligible patients, including high utilizers of services, individuals and families experiencing homelessness, and adults with serious mental illness and / or substance use disorders. Reporting to the Program Manager, the Case Manager is responsible for assessing clients' needs, developing tailored care plans, and coordinating a range of resources to enhance their well-being. This position collaborates closely with a multidisciplinary team to facilitate effective communication, monitor progress, and advocate for optimal outcomes.

Principal Responsibilities :

• Collaborate with providers, managed care plans, the Housing Navigation Team, and community homeless service providers to ensure seamless care coordination for eligible patients.
• Perform comprehensive case management services, including intake, assessment, personalized care plan development, plan implementation, subspecialty referrals, monitoring, and follow-up.
• Connect members with essential social and support services, arranging referrals for specialized care (e.g., ophthalmology, behavioral health, podiatry, and nutrition), transportation, housing, and more.
• Accompany patients / clients to appointments when necessary.
• Advocate on behalf of members when engaging with healthcare professionals to ensure their needs are understood and addressed effectively.
• Utilize motivational interviewing, trauma-informed care, and harm-reduction strategies to foster positive interactions and promote well-being.
• Coordinate closely with clinical staff to establish well-structured discharge plans, ensuring a smooth transition for patients.
• Monitor and encourage treatment adherence, including medication regimens, to support optimal health outcomes.
• Provide health promotion and self-management training to empower patients in taking charge of their well-being.
• Collect and input essential data for reporting purposes, ensuring the accurate completion of project activities and monthly reports as required by funding sources.
• Engage in agency and community meetings to address patient needs and contribute to discussions related to case management concerns.
• Participate in weekly case conferences with PCPs, clinical supervisors, and peers to facilitate collaborative problem solving for client-related challenges and ensure the delivery of high-quality case management services.
• Collect data for comprehensive initial and ongoing assessments of patient needs, including functional status, housing, mental health, substance use, and education.
• Regularly update Individual Service Plans (ISPs) during weekly client meetings and report progress at case conferences to ensure goals are met effectively.
• Provide clients with appropriate referrals for a range of services, including HIV care, housing, food, transportation, benefits counseling, mental health services, and medical support.
• Verify clients' eligibility for public assistance programs and guide them through the necessary steps to access programs such as HWLA, Medi-Cal, SSI, GR, and housing options.
• Maintain confidentiality regarding client and employee information.
• Participate in designated staff meetings, quality improvement initiatives, case conferences, and in-service trainings.
• Perform other duties as assigned.

Requirements :

Employee Benefits :

At JWCH Institute, Inc., we believe in taking care of those who take care of others. If you work 30+ hours per week, you’ll enjoy competitive pay and a robust benefits package that includes :

Become part of a team where your work matters. Apply today and help us change lives, one patient at a time.

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

Monday through Friday 8 : 00am - 5 : 00pm