Care Manager II

At the Institute on Aging (IOA), we believe in enhancing the quality of life for individuals as they age, enabling them to maintain their health, well-being, independence, and participation in the community. For nearly 40 years, we’ve been dedicated to helping older adults and those with disabilities age in the place they call home.
* Now, we're calling on compassionate individuals to join our mission.
** Why You'll Love Working Here*
* * Hybrid

Schedule:

* Enjoy the flexibility to balance your work and personal life.
* * Work-Life Balance:
* We understand the importance of maintaining a healthy work-life balance.
* * Robust Benefits Package:
* Comprehensive health coverage, retirement plans, and more.
* * Advancement Opportunities:
* Grow your career with us.

Job Description

Summary:

Responsible for the assessment of clients with multiple medical and psychosocial needs. Plans for and monitors services and interventions ensuring provision of quality care.

RESPONSIBILITIES:
* Conducts comprehensive assessments and on-going re-assessments of the client including psychosocial, physical and mental health, environmental and spiritual needs.
* Writes comprehensive assessments. Based on assessment information with the client develops and initiates the Community Living Plan, which is client-centered, comprehensive and consistent with program guidelines and policies and procedures.
* Conducts home visits, acute hospital & skilled nursing facility visits, as well as escorts clients to medical and other appointments as clinically indicated.
* Identifies, arranges for, and monitors appropriate community services based on a good knowledge of Medicare, Medi-Cal, and other entitlement programs.
* Establishes and maintains a care management relationship with clients and their informal support network as appropriate, offering respect, dignity and support. Provides crisis intervention, advocacy, problem solving and therapeutic interventions.
* Meets with clients at least monthly, and more often as clinically indicated. Reviews and modifies their Community Living Plan on an ongoing basis.
* Documents via progress notes all case management activity regarding identified problems within 24-48 hours, adding any new problems to the Community Living Plan, as needed.
* Maintains required paperwork and follows a clear, concise, and consistent system of charting to allow for continuity of care.
* Ongoing evaluation for client Purchase of Service needs and follow-up to determine if services have been provided in a timely manner.
* Educates clients and informal support network about resources.
* Establishes and maintains open and effective communication with community providers, including physicians and other health care and social service workers. Provides appropriate information on all significant aspects of individual client care and program operations, while maintaining necessary confidentiality.
* Monitors the quantity and quality of the services provided by other involved providers.
* Working closely with the team, continuously evaluates the clients’ ability to remain safely at home, coordinates placement as appropriate, according to program guidelines.
* In collaboration with the client, caregiver, and involved services, terminates clients when appropriate. Documents the process as required.
* Participates in research studies and data collection, as required.
* Participates in and promotes ongoing efforts towards Continuous Quality Improvement.
* Attends and actively participates in team and program meetings, activities and problem-solving endeavors; contributes to open lines of communication within the team.
* Utilizes supervision appropriately, maintaining open lines of communication and providing updates on caseload activity.
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