Case Manager - Carson

The Case Manager provides person-centered, recovery- and resiliency-oriented case
management, rehabilitation, outreach, care coordination, and resource linkage to clients and families
across Agency programs. Services may be delivered in clinic, home, school, community, telehealth, and
other approved settings based on client need, preference, level of care, and program requirements.

• 1. CASE MANAGEMENT AND CARE COORDINATION: Maintains an assigned caseload and provides individualized case management based on client strengths, needs, acuity, goals, and level of care. Coordinates behavioral health, medical, substance use, housing, benefits, education, employment, legal, and community support. May serve as Primary Care Coordinator when required by the assigned program.
• 2. OUTREACH AND ENGAGEMENT: Participates in persistent, culturally and linguistically responsive outreach, engagement, re-engagement, and warm handoffs. Follows applicable LACDMH timelines and requirements for referral, enrollment, transfer, and disenrollment.
• 3. NEEDS IDENTIFICATION AND SERVICE PLANNING: Collaborates with clients, families/caregivers when applicable, and the treatment team to identify behavioral health, functional, housing, substance use, physical health, safety, benefits, educational, employment, and natural-support needs. Contributes to person-centered care planning and supports CANS, LOCUS, Child and Family Team (CFT), and other required level-of-care processes as applicable.
• 4. REHABILITATION AND SKILL DEVELOPMENT: Provides rehabilitation and skill-building interventions within scope to strengthen coping, daily living, communication, self-advocacy, community functioning, recovery, and resiliency. When assigned to High Fidelity Wraparound (HFW), participates in services consistent with the individualized plan of care, CFT process, and applicable fidelity standards.
• 5. HOUSING, BENEFITS, AND COMMUNITY RESOURCES: Assists clients with housing, benefits, basic needs, transportation, identification documents, and community-resource linkage. Supports housing assessment, planning, retention, landlord communication, Coordinated Entry, and Managed Care Plan/community support when required. The position does not guarantee housing or financial assistance.
• 6. CO-OCCURRING, HEALTH, AND MEDICATION SUPPORT: Uses recovery-oriented, trauma-informed, and harm-reduction approaches to support clients with co-occurring mental health and substance use needs. Provides screening support, education, and linkage within scope, including connection to SUD treatment or medication-assisted treatment when indicated. Coordinates access to psychiatric, primary care, and medication services without performing duties outside scope.
• 7. CRISIS RESPONSE AND SAFETY: Provides crisis prevention, de-escalation, stabilization, coordination, and follow-up within training and scope. Promptly communicates changes in risk, obtains higher-level clinical or emergency support when needed, and follows mandated reporting requirements, incident reporting procedures, and Agency safety protocols.
• 8. FIELD-BASED AND FLEXIBLE SERVICE DELIVERY: Provides field-capable services in approved settings based on client preference, clinical determination, and program requirements. Meets applicable service-frequency, face-to-face, field-based, caseload, and scheduling expectations, including increased field service for intensive levels of care when required.
• 9. COLLABORATION AND TEAM PARTICIPATION: Participates in treatment planning, supervision, case consultation, staff meetings, CFT meetings when applicable, and care transitions. Coordinates with multidisciplinary team members, schools, child welfare, justice partners, hospitals, Managed Care Plans, housing providers, county partners, and other authorized providers.
• 10. DOCUMENTATION, QUALITY, AND COMPLIANCE: Completes accurate and timely documentation of services, outreach, care coordination, referrals, progress, and incidents. Meets applicable productivity, outcome, data-reporting, quality assurance, audit, and program-monitoring requirements. When providing an evidence-based practice, follows required training, certification, fidelity, and data-collection standards.
• 11. CONFIDENTIALITY, PROFESSIONAL CONDUCT, AND TRAINING: Maintains confidentiality, professional boundaries, and compliance with HIPAA, Medi-Cal/SMHS, LACDMH, ethical, and Agency requirements. Completes required orientation, supervision, continuing education,…