Aviva Family and Children’s Services Mission Statement

Aviva believes every child and every family in our Los Angeles community deserves the chance for a brighter future. We provide compassionate support, therapeutic services, and guidance to at-risk children and families.

Job Summary

Under the direction of the Program Services Senior Case Manager the Lead Care Manager (LCM) provides direct service, as well as coordinates care management and functions as a part of a "Care Team" for the Enhanced Care Management Program (ECM). The LCM oversees specific cases, coordinates health care benefits, provides education and facilitates client access to care in a timely and cost-effective manner. The LCM collaborates and communicates with clients, caregivers/family support persons, and other providers to promote wellness, recovery, independence, resilience, and empowerment, while ensuring access to appropriate services and maximizing client benefit. The LCM also serves as an advocate for clients, an active client of the interdisciplinary team, a liaison with other programs and external health and social service providers in the community.

The LCM is an energetic self-starter who is able to function comfortably in a team environment or independently and relates well to co-workers and County representatives. This position requires flexibility and the ability to manage time and multiple tasks with little supervision. The individual in this position must be able to assume a wide range of responsibilities, provide timely responses to requests and deadlines and work well under pressure.

Essential Functions

• Assess client needs in the areas of physical health; mental health; SUD; oral health; trauma- informed care; social supports; housing; vocational/employment; wellness; and referral and linkage to community-based services and supports.
• Oversees the development and implementation of the Individual Care Plan/Health Action Plan
• Offer services where the client lives, seeks care, or finds most easily accessible, including office-based, telehealth, or field-based services.
• Connect clients to other social services and supports that are needed (e.g., community support group).
• With permission, coordinate/advocate on behalf of client with health care professionals (e.g., PCP)
• Utilize evidence-based practices, such as Motivational Interviewing, Harm Reduction Techniques, and Trauma- Informed Care principles.
• Work collaboratively with hospital staff regarding Transitional Care Planning
• Conduct outreach and engagement activities to facilitate linkage to the ECM program. Outreach and Engagement consists of phone calls, mailed information, and field visits.
• Accompany clients to office visits, as needed and appropriate.
• Evaluate progress and update goals.
• Provide mental health promotion.
• Arrange transportation
• Complete all documentation within the timeframes established by the individual action plans
• Attend weekly staff/team meetings and supervision.

• Attend training as assigned (e.g., ACEs Certification). Works to promote and support justice, equity, diversity, and inclusion at all levels in the organization.
• Works to promote a trauma-informed work environment

The LCM will take on special projects or additional duties as assigned

Competency Requirements

• Ability to speak, read, write and understand English and excellent oral and written communication skills

• Ability to work effectively as a member of the treatment team
• Ability to promptly and appropriately respond to a crisis situation
• Must demonstrate attention to detail
• Must have excellent customer service skills and phone manner
• Interpersonal savvy, demonstrated by the ability to interact with and influence people to establish trust and build strong relationships
• Experience with usage of EMR/EHRs/Care Management software
• Strong organization skills and ability to manage and maintain a personal schedule
• Ability to establish priorities and meet deadlines
• Ability to work independently within a virtual operating environment and as part of a team
• Ability to exercise judgment in the application of professional services
• Active listening skills and genuine compassion for others
• Enjoys collaboration within a team environment and working with people of different skills and experience
• Knowledge of community resources in the local market
• Able to maintain clear professional boundaries with patients and coworkers
• Commitment to represent the company with professionalism
• Demonstrates cultural competency and ability to work with diverse groups of community clients
• Comfortable using computer for documentation, communication, and organizing work

Minimum Requirements:

• At least 3 years of relevant work experience
• High school graduate or GED required
• Long-time resident of the community with good knowledge of the resources of this community
• Ability to complete the training program and ongoing educational requirements as assigned
• Ability to work flexible hours, including occasional night/weekend work
• Multilingual capabilities preferred, but not required
• Prior experience as a Community Health Worker, Peer Support Specialist, Medical Assistant or similar role a plus
• Bilingual (English/Spanish) preferred

Certifications/Licenses

• Valid CA driver’s license

Additional Requirements

• Tuberculosis clearance
• Department of Justice/Fingerprint clearance
• Satisfactory completion of health screening
• Proof of legal eligibility to work in the United States
• Satisfactory driving record

Physical Demands

While performing the duties of a Senior Case Manager, the employee is frequently required to sit, stand, and use their fingers to manipulate a keyboard or writing instrument. The employee is required to drive between offices, schools, homes, and elsewhere within the community. The employee is occasionally required to walk, bend, drive, and lift objects heavier than ten pounds. The employee is rarely required to run.

Work Environment

The work environment is indoors and outdoors. The noise level varies from quiet to moderate.

This Job Description has been developed to identify some of the duties and responsibilities of this position. It is not intended to limit or encompass all duties and responsibilities of the position.

Aviva Family and Children's Services at its sole and absolute discretion, expressly reserves the right to modify, supplement, delete or augment the duties and responsibilities specified in this and all job descriptions.