Role Overview
Under the direction of the Assistant Director/Unit Manager and/or Clinical Consultant, 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.
DUTIES AND RESPONSIBILITIES:
● 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).
KNOWLEDGE, SKILLS & ABILITIES:
● Interpersonal savvy, demonstrated by the ability to interact with and influence people to establish trust and build strong relationships
● Ability to do home visits and outreach
● 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
● Excellent oral and written communication skills
● 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
PREFERRED QUALIFICATIONS:
● Multilingual capabilities preferred, but not required
● Prior experience as a Community Health Worker, Peer Support Specialist, Medical Assistant or similar role a plus
Pay: $52,000.00 per year
Benefits:
Work Location: In person
