Care Manager II in Low Desert and/ or High Desert (Casual - Per Diem, Remote)

Home Community Base Alternative Waiver Program-Inland Empire San Bernardino, California


Description

You may think “old” when you think of Institute on Aging (IOA) because we offer services for seniors 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.

The HCBA Waiver program 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 nurse and social worker. 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 support 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.

The HCBA Waiver program is seeking a Casual Status (i.e., per diem) Care Manager II (“CMII”). This is a casual - per diem position and temporarily remote first work model.

The CMII will 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 annual face-to-face visits, reassessments, and care plan updates

 

REQUIRED QUALIFICATIONS

  • M.S.W. (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 and/or persons with disabilities living in the community
  • Experience with, and understanding of the medical and psychosocial problems of functionally impaired adults and older adults
  • Exceptional communication and presentation skills relating to functionally impaired 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
  • Extensive travel around Riverside and San Bernardino County required
  • Must have own vehicle for transportation to and from work, including travel between worksites or other locations

 

DESIRED QUALIFICATIONS

  • Experience working with individuals with mental and/or behavioral health diagnoses and substance abuse disorders
  • Exceptional interpersonal, oral and written communication skills
  • Bilingual English and Spanish capability

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 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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