CalAIM Lead Care Manager

Position Title:

Lead Care Manager

Classification:

Full-time, Non-exempt

OUR MISSION:

Abrazar (to Embrace in Spanish) is a non-profit, direct-service organization providing services to residents in Orange County. Abrazar is dedicated to embracing the diversity of families in our community, educating them on the resources we provide through our community collaborations, and empowering them to improve the quality of their lives through programs addressing health equity. Abrazar has been addressing inequities in the social drivers of health since 1975.

Abrazar serves the community by delivering programs that address the social drivers of health and improve health equity. Our goals are to Embrace, Educate and Empower children, families, and individuals with the necessary tools to achieve better health outcomes. We believe that diversity and the delivery of collaborative services are critical to the success of our programs and measure the impact of our programs by evaluating their ability to enhance our clients' social drivers of health.

Position Summary:

California Advancing and Innovating Medi-Cal (CalAIM) is a multi-year initiative by the Department of Health Care Services (DHCS) that aims to revolutionize healthcare for all Californians. As an ECM Lead Care Manager, you will play a pivotal role in this historic change by helping CalOptima Health members navigate the healthcare system and access comprehensive care. You will be at the forefront of creating a more coordinated, person-centered, and equitable health system that goes beyond traditional clinical settings and addresses all physical and mental health needs.

The ECM Lead Care Manager assists CalOptima Health members with complex healthcare needs in navigating the healthcare system by resolving access challenges, establishing relationships with service providers, coordinating comprehensive care, and tracking health interventions and outcomes.

This position is non-clinical.

Position Responsibilities:

• Provide all necessary and indicated direct services and referrals
• Provide the seven ECM core services, which include the following:
  • Outreach and engagement
  • Comprehensive assessment and care management plan
  • Enhanced care coordination
  • Health promotion
  • Comprehensive transitional care
  • Member and family supports
  • Coordination of and referral to community and social support services
• Conduct initial and periodic assessments of members to determine their needs, including medical, mental health, substance use, financial, housing, and other supports in compliance with program and funder requirements.
• Maintain accurate, clear, and concise documentation and records of member interactions, referrals, and services provided.
• Build relationships and enhance communication between community partners and providers servicing the members.
• Develop person-centered care plans with input and approval from providers and members in accordance with CalAIM standards.
• Collaborate with medical professionals to develop, implement, and coordinate care plans for members with chronic illnesses, such as diabetes, asthma, heart failure, hypertension, behavioral health conditions, and HIV.
• Maintain member engagement and uphold program standards while conducting in-person and virtual meetings.

REQUIREMENTS

We're looking for candidates who:

• Have knowledge of chronic medical conditions, mental illness, substance use, and homelessness, as well as a basic understanding of public benefits and entitlements.
• Have excellent case management and documentation skills, including the ability to conduct needs assessments, prioritize member needs, develop action plans, and monitor progress.
• Can manage and handle confidential information in accordance with HIPAA standards.
• Are highly motivated self-starters who can coordinate and complete multiple projects and tasks in a high-pressure environment.
• Can thrive in dynamic environments and readily adapt to change.
• Have strong commitment to and understanding of Abrazar’s goals and objectives.
• Have the flexibility to work some evenings and weekends as needed.

PREFERRED QUALIFICATIONS

• Training in Motivational Interviewing, Trauma-Informed Care, Harm Reduction, Crisis Intervention, De-Escalation, Domestic Violence, Substance Use, Suicide Prevention, or other related training.
• Have extensive housing navigation experience or experience working as a housing specialist, preferably in Orange County.
• Have experience assisting clients with applying for benefits (such as Medi-Cal, CalFresh, and CalWORKs) and/or navigating the healthcare system and health insurance.
• Experience and expertise in community outreach and engagement
• 2+ years of experience with case management and using data management systems
• Computer proficiency in Microsoft Office (Word, Excel, and PowerPoint)—knowledge of and experience with Efforts to Outcomes software a bonus.
• Intermediate to advanced level of proficiency in Microsoft Excel
• Capacity to work effectively both independently and as part of a team.
• Some knowledge of available programs and services in Orange County.
• Excellent oral and written communication skills
• Excellent presentational skills

MINIMUM QUALIFICATIONS

• Bachelor's Degree in a related field.
• One (1) year of experience in case management working with vulnerable populations, particularly those with health, mental health, and substance use issues and/or one (1) year of experience in healthcare, case management, and/or homeless services.
• Demonstrated proficiency with computers and technology used for work outputs, particularly with Microsoft Office Suite and data management systems
• Spanish bilingual (Spanish & English) or Vietnamese bilingual (Vietnamese & English).
• Availability to work on occasional Saturdays.

MANDATORY REQUIREMENTS

Regardless of qualifications, candidates must:

• Have employment eligibility verification
• Have or be able and willing to obtain CPR/First Aid training
• Successfully complete the following as a condition of hire:
  1. Tuberculosis Test
  2. Background Screening
  3. Drug Test

DRIVING
Driving is an essential function of this position. To meet the employment requirements for this role, all candidates must:

• Have reliable transportation
• A valid driver's license
• Proof of insurance and ownership for personal vehicles used during work duties
• The ability to qualify for Abrazar’s insurance coverage

PHYSICAL, MENTAL AND ENVIRONMENTAL DEMANDS AND CONDITIONS:

• Must possess body mobility to stand and/or sit frequently or for an extended period of time at meetings, trainings, conferences or community events in office or offsite community locations
• Must be able to function effectively in a standard office environment and have the ability to move about to perform daily office tasks such as access files cabinets and office machinery
• Must be able to communicate information accurately, clearly and concisely in normal vocal tone
• Must be able to transport laptop, files and/or other materials to and from meetings
• Must be able to drive to meet with members at various locations
• Must possess manual dexterity sufficient to use hands, arms and shoulders to operate a keyboard, take notes, utilize office equipment, complete and file reports, and file and copy documents
• Must possess sufficient vision to read standard text
• Must possess the ability to independently reason logically to analyze data, reach conclusions and make recommendations as required in the accomplishment of job duties
• Occasionally/Frequently/Continually required to stand
• Occasionally/Frequently/Continually required to walk
• Occasionally/Frequently/Continually required to sit
• Occasionally/Frequently/Continually required to utilize hand and finger dexterity
• Occasionally/Frequently/Continually required to climb, balance, bend, stoop, kneel or crawl
• Occasionally/Frequently/Continually required to talk or hear
• Occasionally/Frequently/Continually exposure to outside weather conditions
• Occasionally/Frequently/Continually exposure to extreme heat or cold (non-weather)
• While performing the duties of this job, the noise level in the work environment is usually moderate.
• The employee must occasionally lift and /or move more than 50 pounds

Benefits:

• Minimum start $23-25 hourly
• Paid Time Off - Vacation (12 days per year), after 3 months, accrued monthly.
• Paid Time Off – Health (56 maximum hours per fiscal year), after 3 months.
• Holiday Pay (10 days per year), eligible after 3 months.
• Health Insurance
• Dental and Vision Insurance

This description reflects management’s assignment of essential functions. This job description is subject to change at any time. This description is intended to indicate the kinds of work duties that will be required in this position. It is not intended to limit, or in any way modify, the rights of any supervisor to assign, direct, and contract work of staff under his/her supervision. The use of a particular illustration describing duties shall not be held to exclude other duties, not mentioned, that are of a similar level or difficulty. Diversity in organizational practices is a core value of ABRAZAR resulting in culturally competent services, materials, resources, and programs. Our hiring and business practices appreciate the strengths offered through different backgrounds.

About Abrazar (to Embrace)

Abrazar (to Embrace) is a 501 (c) 3 non-profit organization that provides shuttle bus and non-emergency medical transportation to patients. Abrazar is dedicated to promoting the general welfare and prosperity of very poor to medium income seniors and families in Orange County through programs that improve health, nutrition, socialization, lifelong learning and economic self-sufficiency in culturally sensitive ways

Abrazar is an Equal Opportunity Employer and does not discriminate on the basis of race, ethnicity, religion, gender, age, physical disability, and sexual orientation. Abrazar complies with all EEO and ADA guidelines.