Case Manager

The Case Manager plays a vital role in providing comprehensive harm reduction-focused case management to individuals experiencing homelessness, substance use disorders, and serious mental illness. This position focuses on connecting clients with housing, healthcare, and social services to promote long-term stability and well-being. Working closely with a multidisciplinary team, the Case Manager ensures a client-centered approach, using trauma-informed care, harm reduction strategies, and motivational interviewing to empower individuals in their journey toward improved health and stability.

Principle Responsibilities: 

1. Conduct intake assessments to determine client needs, including housing, mental health, substance use, medical care, and social services.
2. Develop and maintain Individual Service Plans (ISPs), updating them regularly based on client progress and needs.
3. Connect clients to community-based services, including behavioral health, substance use treatment, housing, food assistance, and transportation.
4. Accompany clients to medical, housing, and social service appointments as needed.
5. Advocate for client needs with healthcare providers, ensuring equitable access to services.
6. Utilize harm reduction principles to support clients where they are in their journey, reducing barriers to care and engagement.
7. Provide health education, self-management coaching, and overdose prevention training to clients.
8. Engage in motivational interviewing and trauma-informed approaches to build trust and promote client-driven solutions.
9. Encourage treatment adherence and assist in medication management support.
10. Accurately document case notes, assessments, referrals, and care plans in the electronic health record (EHR) system.
11. Track client progress and collect data for reporting to funders and program evaluation.
12. Participate in weekly case conferences with clinical teams to discuss client needs and challenges.
13. Maintain strict confidentiality and compliance with HIPAA and agency policies.
14. Participate in staff training, quality improvement initiatives, and team meetings.
15. Assist in program outreach and community engagement to connect hard-to-reach populations with services.
16. Support crisis intervention and emergency response efforts as needed.
17. Adhere to all organizational safety policies, procedures, and regulatory requirements to ensure a safe environment for patients, staff, and visitors.
18. Participate in required safety and compliance trainings and apply learned practices in daily work activities.
19. Identify, report, and help mitigate unsafe conditions, incidents, or hazards in the workplace.
20. Use equipment, tools, and supplies safely and responsibly in accordance with organizational and regulatory standards.
21. Maintain awareness of infection control, occupational health, and emergency preparedness procedures appropriate to the role.
22. Participate in JWCH’s customer service training called AIDET on an annual basis.
    1.  Demonstrate an understanding of AIDET (Acknowledge, Introduce, Duration, Explanation, and Thank You) to apply in patient encounters or team discussions.
    2.  Utilize the AIDET communication framework to communicate with patients and team members in a manner that reduces patient anxiety, increases patient compliance, and improves clinical outcomes.
23. Perform other duties as assigned.

Requirements:

1. 1. High school diploma or GED required; Medical Assistant certification preferred.
   2. At least two years of experience in case management, care coordination, or a related role.
   3. Experience working with homeless populations, individuals with chronic conditions, and frequent hospital utilizers.
   4. Knowledge of harm reduction, trauma-informed care, and motivational interviewing techniques.
   5. Proficiency in electronic health records (EHR) and data entry.
   6. Strong communication, active listening, and crisis intervention skills.
   7. Cultural competence and ability to work with diverse populations.
   8. Possess a valid CA Driver’s License, maintain a clean driving record, and be able to travel to different sites.
   9. Bilingual (English/Spanish) preferred.