Care Manager II

Home Community Base Alternative Waiver Program-San Francisco San Francisco, California


Description

You may think “old” when you think of Institute on Aging (“IOA”) because we offer services for elders and are a 40+ year institute…. but you wouldn’t be more wrong. While we do have a long-standing history in California, IOA is on the forefront of revolutionary healthcare models, reshaping the way people can age in place. Our innovative models transform lives, enhance communities, and save healthcare systems millions of dollars. Rather than focusing on archaic outdated design, we strive to consistently question the “status-quo” and create new and more innovative ways to help aging adults maintain their quality of life. With over 23 programs, we offer multiple ways to aid seniors maintain their health, well-being, independence and participation in the community, fulfilling our mission.

Community Living Services (CLS), IOA’s fastest growing business unit, is an innovative and revolutionary healthcare model that allows seniors to live at home longer by transitioning them out of nursing homes and back into the community by partnering with health plans and Medi-Cal. This inventive, nationally recognized model is one of the most promising for seniors to date, transforming their lives by providing them with a higher quality and more independent life and saving millions of dollars for healthcare systems.

The HCBA Waiver Program team within CLS provides care management services to persons at risk for nursing home or institutional placement. The care management services are provided by a multidisciplinary care team comprised of a registered Nurse and Social Worker/Care Manager.  The care management team coordinates Waiver and State Plan services (e.g., medical, behavioral health, In-Home Supportive Services, etc.), and arranges for other available long-term services and supports available in the local community. Care management and Waiver services are provided in the Participant’s community-based residence. This residence can be privately owned, secured through a tenant lease arrangement, or the residence of a Participant’s family member. 

 

HCBA is seeking a Full Time Care Manager II to conduct comprehensive health and psychosocial assessments of participants’ medical needs, diagnose functional and cognitive abilities and environmental and social needs to determine which service(s) are required to meet participants’ needs and preferences in the community.  Other key duties and responsibilities include, but may not be limited to the following:

  • Documenting assessment, case notes, care coordination, and utilization management within the Med Compass system, a population health management software   
  • Working with the participants, their legal representatives, circles of support, and primary care physicians to:
    • develop goals associated with the participant’s assessed needs, individual circumstances, and preferences
    • develop a Plan of Treatment (POT) to mitigate risk and minimize disruptions in services
    • identify when services identified in the POT are available through friends, family, and/or publicly funded programs
  • implement the POT, which includes identifying service providers and community resources to help assure the timely, effective, and efficient mobilization and allocation of the services
  • identify (and train, if necessary), backup caregivers who are willing and able to provide unpaid support when waiver service providers do not arrive when scheduled.
  • Providing information, education, counseling, and advocacy to, and on behalf of participants
  • Establishing a care coordination schedule based on the needs and acuity of the participant as determined by their initial service needs assessment and subsequent reassessments
  • Monitoring the delivery of HCBA Waiver services to ensure participants are receiving services as authorized in their POTs
  • Monitoring the quality of the authorized services by maintaining ongoing contact with participants - including a monthly face-to-face visit or telephone call - to monitor for changes in health, mood, social integration, functionality, and overall well-being
  • Conducting face-to-face visits when needed depending on LOC, reassessments, and care plan updates
  • Assisting with monthly case management calls

REQUIRED QUALIFICATIONS

  • Masters’ degree in Social Work or Social Welfare from an accredited college or university
  • One year’s experience working within a community-based case management program with a similar target population
  • Work experience that includes a minimum of 1000 hours providing Case Management services to the elderly, children and/or persons with disabilities living in the community
  • Experience with, and understanding of the medical and psychosocial problems of functionally impaired children, adults, and older adults
  • Exceptional communication and presentation skills relating to functionally impaired children, adults and older adults, their support systems, and teams of health professionals
  • Demonstrated case management skills and experience within the community health care delivery system
  • Excellent detail orientation and problem-solving skills
  • Demonstrated ability to prioritize multiple critical tasks
  • Excellent Computer literacy (Excel, EMR)
  • Enjoys working with a team

 

DESIRED QUALIFICATIONS

  • Experience working with individuals with various medical conditions, mental and/or behavioral health diagnoses and substance abuse disorders
  • Familiarity with medical terminology
  • Exceptional interpersonal, oral and written communication skills

 

 

We encourage you to learn more about IOA by logging onto www.ioaging.org/about-ioa

 

Institute on Aging reserves the right to revise job descriptions or work hours as required.

 

IOA is an Equal Opportunity Employer. IOA is committed to cultivating a diverse and inclusive work environment and providing equal opportunities to all employees and job applicants without regard to age, race, religion, color, national origin, sex, sexual orientation, gender identity, genetic disposition, neurodiversity, disability, veteran status or any other protected category under federal, state and local law. 

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