CalOptima - Case Manager - #261349

HealthRIGHT 360 gives hope, builds health, and changes lives for people in need by providing comprehensive, integrated, compassionate care that includes primary medical care, mental health services, and substance use disorder treatment.

Benefits And Perks

• HR360 offers a robust benefits package, including PTO, 15 paid holidays, commuter benefits, retirement plans, and more!
• Employees qualify for public loan forgiveness programs
• Training and professional development opportunities
• Work with mission driven, compassionate colleagues and make a difference every day in the work that you do.
  
  

CalAIM, a Department of Health Care Services (DHCS) initiative, aims to improve Medi-Cal recipients' quality of life and health outcomes through system reforms. It introduces Enhanced Care Management (ECM), a statewide Medi-Cal Managed Care Plan (MCP), that offers person-centered, community-based highest care management tier within the Medi-Cal MCP Population Health Management continuum. Participating members are assigned a Case Manager who will meet them wherever they are: on the street, in a shelter, in their provider’s office, or at home to coordinate their health-related care and services, ensuring holistic approach to their well-being. In addition, ECM offers community-based services to address health-related social needs to help members live healthier lives and avoid more costly levels of care. Some examples include support to secure and maintain housing, access to medically tailored meals for short-term recovery, and various other community-based services.

HealthRIGHT 360 Case Manager facilitates care by connecting clients with suitable services to meet their needs, including physical and mental health, substance use issues, employment (both residential and outpatient), legal concerns, housing, community resources, and aftercare. This role involves working directly with members in diverse settings such as their homes, homeless encampments, service provider locations, and other areas requiring outreach.

Key Responsibilities

Enrollment and Engagement

• Identify eligible individuals from various locations for enrollment into CalOptima’s MCP.
• Use multiple strategies for engagement (in-person meetings, mail, email, texts, telephone, community outreach).
  
  

Client Care Activities

• Organize client care activities according to CalOptima's Managed Care Plan (MCP).
• Share information with the client’s multi-disciplinary care team.
• Implement activities identified in the MCP.
• Provide support to engage clients in their treatment including medication review, appointment scheduling, transportation coordination, and addressing barriers to engagement.
• Assist with intake by completing required assessments.
• Connect clients to benefits, healthcare services, employment, housing, and community resources.
• Monitor client’s progress toward achieving treatment plan goals and provide treatment plan input.
  
  

Care Coordination

• Maintain regular contact with all providers involved in the client’s care team.
• Ensure continuous and integrated care among all service providers.
• Refer and follow up with primary care, mental health, substance use disorder treatment, and necessary community-based services.
• Collaborate with clients and their families for community reintegration.
• Collaborate with outside agencies to obtain needed community resources (housing, sober livings, substance abuse recovery agencies, medical facilities, employment/education agencies, DPSS, DMV or other needed resources).
• Communicate collaboratively with all members of the behavioral health team.
  
  

Field-Based Responsibilities

• Meet ECM clients at their physical locations and cater to their individual needs.
• Conduct case management activities in locations most attainable and desirable for clients.
• Have access to office space for case management activities and attend required training and meetings as needed.
• Submit mileage for field-based case management activities for reimbursement.
  
  

Administrative Duties

• Write and complete all progress notes within 24 hours of service delivery.
• Write client progress letters and court reports.
• Actively participate in assigned Group Supervision, agency, and team meetings.
• Participate in training opportunities and complete assigned training in a timely manner.
  
  

And perform other duties as assigned.

Qualifications

Education, Certification, Licensure, and Experience

• High school diploma or equivalent with 2 years’ experience working with Medi-Cal, Medi-Care, and private Medical Insurance plans.
• Case management experience.
• Experience providing trauma-informed services preferred.
• Experience working with clients experiencing acute withdrawal from substances.
• Current First Aid and CPR certification or ability to obtain within 30 days of hire.
• Valid California driver’s license and access to registered and insured transportation.
  
  

Background Check And Other Requirements

• Must complete background check and livescan fingerprinting.
• Capable of meeting health screening and tuberculosis testing requirements.
• Capable of meeting program requirements.
  
  

We will consider for employment qualified applicants with arrest and conviction records.