This culturally and geographically connected individual serves as a link between underserved communities and existing community resources. Through outreach and engagement, this individual assists clients in overcoming barriers to health, social services, education, and employment by connecting them to identified Pathways. This person empowers clients to navigate medical, behavioral health, and social services by removing barriers to these services. An individual interested in pursuing a Lead Case Manager position should be an empathetic individual and preferably have experience working in public health, substance abuse treatment, and/or working with adults at increased risk for hospitalization/ED visits, at risk for long term care institutionalization, and nursing facility residents transitioning to the community .

:

• Advocates for individual and community health needs
• Builds individual and community capacity by increasing health knowledge and self-sufficiency through outreach, community education, informal counseling, social support and advocacy
• Conducts standardized client intake and risk assessments
• Based on assessments, develops and continually updates plan of care based on client-identified health and social services goals
• Participates in the ongoing assessment of client needs via in-person, home, in-office, virtual, and/or telehealth appointments, as appropriate. Similarly, follow-up with clients via telephone, home, or other locations where the client can be found, when appropriate.
• Collaborates with health providers to develop an integrated, holistic solution to help client access services and improve client health outcomes – work closely and cooperatively with other personnel assigned to the same client, including medical providers, behavioral health providers, housing coordinators, legal advocates
• Identifies and helps to enroll eligible individuals in federal, state and local private and non-profit health and human services programs. Assists clients in completing a variety of applications and forms.
• Provides referral and follow-up services or otherwise coordinates care
• Serves as a liaison between communities and health care agencies
• Enhances community member’s ability to effectively communicate with healthcare providers
• Provides culturally and linguistically appropriate health education; promotes integration of culturally appropriate community and practices; assist in developing cultural awareness and competency for staff and volunteers
• Establishes trusting relationships with the target population, referred clients, and community partners.
• Helps clients connect with transportation and/or other resources in order for clients to attend medical appointments. Provides appointment reminders to clients when appropriate
• Participates in specific Adult Day Health interdisciplinary team activities (as appropriate) and/or weekly interdisciplinary team meetings.
• Communicates information to clients in a culturally responsive way that is easily understandable and emotionally supportive
• Explains complex health forms and concepts to clients (including client medical diagnosis) to clients in a way that is understandable to the client
• Attends regular staff meetings and trainings as required

Bachelor’s degree with 2 years of qualifying experience. Experience and knowledge of medical social work scope of practice and knowledge of the special needs of functionally impaired older adults. This position reports to the Program Supervisor. This is a full time position.

Job Type: Full-time

Pay: $28.00 per hour

Expected hours: 40 per week

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Free parking
• Health insurance
• Paid time off
• Vision insurance

Schedule:

• Day shift
• Monday to Friday
• No weekends

Experience:

• Nursing: 1 year (Preferred)
• Case management: 1 year (Preferred)

License/Certification:

• RN (Preferred)

Ability to Commute:

• Palo Alto, CA 94303 (Required)

Ability to Relocate:

• Palo Alto, CA 94303: Relocate before starting work (Required)

Willingness to travel:

• 50% (Required)

Work Location: In person