Care Manager

The Care Manager is responsible for providing care planning and navigation with Hospice SLO County and other area resources tailored to the needs of current and specifically referred client with cognitive impairment or complicated diagnoses. The Care Manager tracks and communicates with these clients and/or their caregivers for as long as it is required to connect the clients with area services, assists them to receive benefits or services, advocates on their behalf (when necessary) with health care providers, and helps create care plan with clients, caregivers, and families.

The Care Manager receives direct referrals from current in-home clients from the Volunteer Services Manager, Hospice SLO County volunteers or staff, and community agencies. These community agencies include direct referrals from physicians, home health agencies, hospitals, social workers, potential clients (or their family members), or other area service providers. The Care Manager works closely with the in-home team to help meet the needs of clients and volunteers wherever possible.

The Care Manager also works with office staff and volunteers to communicate the needs of serving clients.

The position requires organization, good verbal/communication skills, willingness to assess clients in the home environment in all kinds of situations, ability to problem solve, broad knowledge of community and regional resources (and how to qualify), strong assessment skills, and good charting and records keeping.

ESSENTIAL JOB FUNCTIONS

• Assess client needs in home.
• Use a system on Microsoft Excel for tracking clients.
• Record information about client needs and referrals on care plan.
• Use online database and care plan for client notes, follow up and maintain current contact information.
• Use assessment template to create a workable care plan for clients, caregivers, and families.
• Communicate with volunteers through online portal and by email/phone to enhance a team approach to care.
• Coordinate weekly or more often with in-home team members to coordinate care in the program as well as to reach out to other Hospice SLO County team members.
• Engage in community outreach, networking, and communication by attending regular or one-time meetings to understand community resources and referral opportunities.
• Willingness to speak in public for education and outreach.
• Advocate for non-medical hospice and appropriateness for medical hospice/palliative/home health care when needed.

REQUIRED EDUCATION AND EXPERIENCE

• Social Worker, RN, or person with direct care management experience.
• Experience with care coordination and management.

PREFERRED EXPERIENCE

• Experience working in a nonprofit setting.
• Experience in a service organization.
• Speaking and presenting experience.
• Experience with training and education.

COMPETENCIES

• Broad knowledge of community/regional resources and how to engage.
• Good relationships with community resource providers and process of referral.
• Ability to assess and plan care in a variety of situations and for many different diagnoses.
• Ability to protect client confidentiality.
• Good organization, ability to track and follow up on client and volunteer needs in a timely manner.
• Personable, good communicator (written and spoken) and willingness to reach out to others in the community to learn about resources and to promote Hospice SLO County services and partnership opportunities.
• Ability to stay abreast of current needs and opportunities in the community.
• Proficient in Microsoft Word, Excel, Outlook and other computer software plus a willingness to learn new digital skills.
• Willingness to meet clients in person or by phone.
• Maintain constructive relationships and demonstrate respect and a high level of professionalism with a variety of people and personality types.
• Self-motivated with effective time management and organizational skills and ability to accomplish projects with little supervision while asking for assistance when needed.
• Ability to work effectively, efficiently, and creatively in a team environment.
• Must be able to multitask while maintaining accuracy with the ability to respond creatively and diplomatically to conflicting priorities.
• Flexibility and…