Integrated Care Community Liaison

2 weeks ago

San Francisco, California, United States San Francisco Health Plan Full time
Position Overview

Are you passionate about making a positive impact in the San Francisco community? In this essential role, you will be instrumental in driving systemic improvements in health care delivery.

As a Community Care Coordination Specialist, you will report to the Clinical Supervisor of Care Management. Your responsibilities will include conducting comprehensive bio-psychosocial evaluations, developing individualized holistic care strategies, and serving as a vital link among various service providers and community organizations. This role requires a blend of office work and community engagement, including visits to clinics, hospitals, and members' homes.

Key Responsibilities:

  • Perform initial assessments via phone or in-person for members requiring care coordination, evaluating their medical history, psychosocial challenges, resource needs, and functional capabilities.
  • Create and assist in the execution of member-centered, tailored Care Plans.
  • Empower members to identify their strengths and obstacles, supporting them in achieving their Care Plan objectives while honoring their health choices.
  • Monitor access barriers and quality concerns, aiding members with grievances and escalating issues to program leadership as necessary.
  • Guide members through the complex landscape of providers and social service agencies.
  • Assist members and their caregivers in reassessing and adjusting Care Plan goals.
  • Conduct home visits, provide transportation to medical appointments, and engage with members in various community settings.
  • Collaborate with the Care Management nurse to support individuals in managing chronic conditions and medication adherence.
  • Work alongside the nurse to complete medical assessments and align care plan goals.
  • Engage with hospitals, long-term care facilities, outpatient providers, and community agencies to facilitate referrals for mental health care, substance use treatment, and other health-related needs.

Qualifications:

  • A minimum of one year of experience in community outreach. A Master's or Bachelor's degree in a relevant field is preferred, though experience in case management and outreach may substitute for formal education.
  • Experience working with individuals facing mental health challenges, addiction, or homelessness.
  • Familiarity with clients who have multiple diagnoses and barriers to care.
  • A commitment to serving homeless populations in their environments.
  • Ability to thrive in both community and office settings, particularly in diverse cultural contexts.
  • Proficiency in Spanish or Chinese is highly desirable.
  • Knowledge of Medi-Cal or Department of Health Care Services regulations is advantageous.
  • Competence in Microsoft Office applications such as Word, Excel, Outlook, and Access.
  • Understanding of Trauma-Informed Care, Harm Reduction, and Person-Centered approaches.
  • Successful completion of a sex offender registry screening is required due to the nature of home visits.

Benefits:

  • Health Coverage: Choose from various medical plans, including options from Kaiser and Blue Shield of California, with significant employer subsidies.
  • Dental and Vision: Select from basic or enhanced dental plans, along with vision care coverage through Vision Service Plan (VSP).
  • Retirement Plans: Employer-matched CalPERS Pension and 401(a) plans, along with a 457 Plan.
  • Paid Time Off: Enjoy 23 days of Paid Time Off (PTO) and 13 paid holidays annually.
  • Professional Growth: Opportunities for tuition reimbursement and support for professional licensing and memberships.

About Us:

San Francisco Health Plan (SFHP) has been dedicated to providing affordable health care coverage to low and moderate-income residents of San Francisco County since 1997. With a mission to serve the underserved, SFHP is a trusted choice for Medi-Cal managed care enrollees, offering comprehensive medical services including preventive care, specialty care, hospitalization, and more.

We are proud to be an equal opportunity employer, fostering a work environment that respects and supports all individuals. We adhere to the San Francisco Fair Chance Ordinance, considering qualified applicants with arrest and conviction records.

San Francisco Health Plan is an E-Verify participating employer.

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