Case Manager I/II

Job Overview

CalAIM, a Department of Health Care Services (DHCS) initiative, aims to improve Medi-Cal recipients' quality of life and health outcomes through system reforms.

It introduces Enhanced Care Management (ECM), a statewide Medi-Cal Managed Care Plan (MCP), that offers person-centered, community-based highest care management tier within the Medi-Cal MCP Population Health Management continuum.

Participating members are assigned a Case Manager who will meet them wherever they are : on the street, in a shelter, in their provider’s office, or at home to coordinate their health-related care and services, ensuring holistic approach to their well-being.

In addition, ECM offers community-based services to address health-related social needs to help members live healthier lives and avoid more costly levels of care.

Some examples include support to secure and maintain housing, access to medically tailored meals for short-term recovery, and various other community-based services.

The Case Manager I / II facilitates care by connecting clients with suitable services to meet their needs, including physical and mental health, substance use issues, employment (both residential and outpatient), legal concerns, housing, community resources, and aftercare.

This role involves working directly with members in diverse settings such as their homes, homeless encampments, service provider locations, and other areas requiring outreach.

Key Responsibilities

Enrollment and Engagement

• Identify eligible individuals from various locations for enrollment into CalOptima’s MCP.
• Use multiple strategies for engagement (in-person meetings, mail, email, texts, telephone, community outreach).

Client Care Activities

• Organize client care activities according to CalOptima's Managed Care Plan (MCP).
• Share information with the client’s multi-disciplinary care team.
• Implement activities identified in the MCP.
• Provide support to engage clients in their treatment including medication review, appointment scheduling, transportation coordination, and addressing barriers to engagement.
• Assist with intake by completing required assessments.
• Connect clients to benefits, healthcare services, employment, housing, and community resources.
• Monitor client’s progress toward achieving treatment plan goals and provide treatment plan input.

Care Coordination

• Maintain regular contact with all providers involved in the client’s care team.
• Ensure continuous and integrated care among all service providers.
• Refer and follow up with primary care, mental health, substance use disorder treatment, and necessary community-based services.
• Collaborate with clients and their families for community reintegration.
• Collaborate with outside agencies to obtain needed community resources (housing, sober livings, substance abuse recovery agencies, medical facilities, employment / education agencies, DPSS, DMV or other needed resources).
• Communicate collaboratively with all members of the behavioral health team.

Field-Based Responsibilities

• Meet ECM clients at their physical locations and cater to their individual needs.
• Conduct case management activities in locations most attainable and desirable for clients.
• Have access to office space for case management activities and attend required training and meetings as needed.
• Submit mileage for field-based case management activities for reimbursement.

Administrative Duties

• Write and complete all progress notes within 24 hours of service delivery.
• Write client progress letters and court reports.
• Actively participate in assigned Group Supervision, agency, and team meetings.
• Participate in training opportunities and complete assigned training in a timely manner.

And perform other duties as assigned.

Education and Knowledge, Skills and Abilities

Education, Certification, Licensure, and Experience

• High school diploma or equivalent with 2 years’ experience working with Medi-Cal, Medi-Care, and private Medical Insurance plans.
• Case management experience.
• Experience providing trauma-informed services preferred.
• Experience working with clients experiencing acute withdrawal from substances.
• Current First Aid and CPR certification or ability to obtain within 30 days of hire.
• Valid California driver’s license and access to registered and insured transportation.

Competencies

• Adaptability. Ability to adapt to changes in the care plan and modify activities as needed to meet the client’s evolving needs.
• Advocacy and Empathy. Ability to advocate for the clients’ needs, support their wishes, and work closely with other providers and family members.
• Care Coordination. Strong coordination skills to manage the health care services of qualified members.
• Communication and Collaboration. Skill in conveying information clearly and accurately, both verbally and in writing, and fostering open and collaborative communication with clients, colleagues, and other stakeholders.

Ability to act as the main point of contact for the clients, ensuring seamless connections to quality care across various settings.

• Computer Literacy. Proficiency with Microsoft applications and EHR systems.
• Cultural Sensitivity. Ability to interface well with diverse, disadvantaged populations while withholding judgment.
• Decision-making. Make informed decisions based on the collected data and research findings to create an effective program foundation.
• Evaluation Skills. Ability to assess eligibility criteria and identify individuals who qualify for enrollment into the program.
• Outreach Skills. Ability to reach out to and engage eligible individuals from diverse locations, including state prisons, county jails, hospitals, and other settings.
• Understanding of High-Need Populations. Knowledgeable about chronic conditions, social determinants of health issues, and utilization across different delivery systems.
• Bilingual preferred.

Background Check and Other Requirements

Capable of obtaining and maintaining a satisfactory background check. Applicants must not be on parole or probation due to funding regulations.

Qualified candidates with a criminal record will be considered for employment.

• Capable of meeting health screening and tuberculosis testing requirements.
• Capable of meeting program requirements.

In compliance with the California Department of Public Health's mandate, all employees must be able to provide proof of COVID-19 vaccination.

Medical and religious exemptions are available.We will consider for employment qualified applicants with arrest and conviction records. Other details

• Pay Type Hourly
8 days ago