Job Summary
Responsible for providing comprehensive case management services to older adults to support aging in place and promote health, safety, independence, and quality of life. Conducts assessments, develops individualized care plans, coordinates services, advocates for clients, and provides ongoing support and follow-up. Maintains accurate and timely documentation of services, client outcomes, and program activities in agency databases. Participates in outreach, education, and community engagement activities to connect vulnerable older adults with available resources and services.
Duties and Responsibilities
- Conduct comprehensive geriatric assessments and develop individualized care plans based on client needs, goals, strengths, and risk factors.
- Provide ongoing case management services, including care coordination, advocacy, monitoring, reassessment, and follow-up to support client goals and promote aging in place.
- Coordinate services with healthcare providers, family members, caregivers, community partners, and other service providers to ensure continuity of care.
- Maintain accurate, thorough, and timely documentation of client contacts, assessments, care plans, service transactions, case notes, and outcomes in accordance with agency, funder, and regulatory requirements.
- Maintain client caseload, including intake, enrollment, ongoing monitoring, reassessment, and case closure as appropriate.
- Provide referrals to community resources and benefits programs and follow up as needed to ensure successful connection to services.
- Advocate on behalf of clients to address barriers to care, access needed resources, and support client self-determination.
- Maintain accurate client and program data within Salesforce and other required databases to support reporting, compliance, quality assurance, and program evaluation activities.
- Support program compliance by ensuring documentation and service records meet agency, contractual, and funder requirements.
- Participate in interdisciplinary case consultations, team meetings, trainings, and program planning activities to support coordinated service delivery.
- Participate in outreach, education, and engagement activities targeted to frail, isolated, vulnerable, and underserved older adults.
- Conduct home visits and community-based visits to complete assessments, provide case management services, and monitor client well-being.
- Assist clients in accessing transportation resources and accompany clients to medical or other appointments when advocacy or support is needed.
- Deliver food bags, assist with essential needs, and pick up prescription medications when necessary to support client health and safety.
- Screen clients for financial assistance, public benefits, and other supportive services as appropriate.
- Participate in emergency response activities and client wellness checks as needed.
- Other duties as assigned by the Director.
Requirements
- Bachelor's degree in Social Work, Gerontology, Psychology, Human Services, or a related field required.
- Minimum of one year of experience working with older adults, individuals with disabilities, or other vulnerable populations.
- Knowledge of aging services, community resources, healthcare systems, and public benefits programs preferred.
- Strong case management, assessment, care coordination, and client advocacy skills.
- Excellent time management skills with the ability to prioritize competing responsibilities and manage a diverse caseload.
- Strong organizational skills and attention to detail.
- Excellent oral, written, and interpersonal communication skills.
- Proficiency with Microsoft Office applications and experience using case management databases such as Salesforce, HMIS, or similar systems.
- Ability to work independently while collaborating effectively within a multidisciplinary team environment.
- Ability to maintain professional boundaries while building effective working relationships with clients, families, and community partners.
- Ability to lift up to 25 pounds.
- Possess a valid California Driver's License, reliable transportation, and automobile insurance.
- Ability to travel throughout the service area to conduct home visits, attend meetings, and participate in community outreach activities.
- Bilingual language in Spanish Required
Disclaimer
The duties and responsibilities listed above describe the general nature and level of work performed and are not intended to be an exhaustive list of all responsibilities, duties, and skills required. Employees may be assigned additional duties as needed to meet the operational needs of the agency. This job description does not constitute an employment contract.
Pay: $30.20 - $31.25 per hour
Benefits:
- 403(b)
- Dental insurance
- Employee assistance program
- Health insurance
- Paid time off
- Retirement plan
- Vision insurance
Work Location: In person
