Care Manager - bilingual (English/Spanish)

The Care Manager provides non-clinical care coordination and navigation to patients and are vital component in our integrated care model and holistic approach to supporting our patients' overall health and well being. 

This position will coordinate interdisciplinary clinic care teams to assist patients in establishing care with a primary care provider and engaging care coordination services. The position will also facilitate care transitions between external care facilities (i.e., Emergency Department, hospital, home health, rehabilitation facilities, etc.) and MNHC, act as a liaison between MNHC and contracted health plans, and reduce barriers to care by coordinating interpretation, transportation, and other enabling services.

Essential Functions & Responsibilities

The Care Manager has the following responsibilities and duties:

• Conducts outreach to eligible and referred patients to offer and engage in care management services.
• Identifies and documents patient’s linguistic need(s), learning style preference(s), transportation need(s) and schedules interpretation and/or transportation services as needed.
• Conducts in-person, comprehensive Initial Health Education and Behavioral Assessments (IHEBA) and assessments of Social Determinants of Health for patients enrolled in care management programs.
• Develops patient-centered, individualized Health Action Plans.  Support patients in their implementation of Health Action Plans.
  • Support patients’ identification of strengths and barriers to ensure optimal and successful Care Plans. Respect patient health choices in the Care Plan process.
  • Track barriers to care, assist patients with eliminating or reducing barriers to obtaining needed services.
  • Refers and connects patients to community, housing, and social supports.  Partners with patient to navigate the system of providers, social service agencies, and other complementary services.
  • Accompany patient to appointments outside of MNHC and conduct home visits.
  • Support nurse, patient, and caregiver(s) in re-assessment of Health Action Plan goals and interventions.
• Leads Care Conferences and other individual and family support services with patient, family members as needed and patient’s Care Team.
• Provide health promotion services including health education, advocacy, and coaching.

Requirements

The Care Manager should have the following skills, education and experience:

• Bachelor's degree required, preferably in social work, public health, or social services-related field(s)
• Must be bilingual (English/Spanish)
• At least 2 years providing direct patient/client service required.
• Familiarity with Medi-Cal, Managed Care, health insurance programs preferred.
• Case management and/or patient advocacy experience preferred.
• Non-profit, community health care setting experience preferred.
• Ability to work with diverse populations and quickly build rapport with patients.
• Experience working with people with homelessness, addiction issues, serious mental illness.  Also, vulnerable older adults and children with Serious Emotional Disturbance.
• Knowledge of community resources, health, and social services in San Francisco City & County preferred.

Who We Are: The Mission Neighborhood Health Center is a non-profit, multi-site community health organization offering comprehensive health services in the Mission and Excelsior districts of San Francisco. We offer primary health care services including adult medicine, pediatrics, behavioral health, family planning, OB/GYN, homeless services, optometry and dental services. We advocate for health equity and deliver innovative, high quality services responsive to the neighborhoods and diverse communities we serve with a focus on the Latino Spanish-Speaking Communities

Benefits:

• Medical Insurance – MNHC pays 90-100% based on plan
• Dental and Vision Insurance – free to employee
• Flex Spend Accts for health & dependent care expenses
• Life Insurance – free basic policy plus voluntary option
• Vacation – 2 weeks (3 weeks after 5 yrs; 4 weeks after 8 yrs)
• 12 Paid Holidays plus your birthday and 12 Sick Days each year
• 40 hours Paid Educational Leave
• 401k Retirement Savings Plan with Company Contribution