La Clínica del Pueblo

Job Description

Job Title: Case Manager

Department: Patient Services/ Health Equity

Supervisor: Director of Health Equity and Strategic Partnerships

Location: The position will work in Washington, DC and Hyattsville, MD

will be working in both locations.

Classification: Non-Exempt/Hourly

Synopsis

The Case Manager plays a key role in implementing patient-centered care plans by coordinating referrals, linkages, and follow-up to essential services and supports. Working collaboratively with a team of fellow Case Managers, the role focuses on assessing and addressing Health-Related Social Needs (HRSNs). This position requires close collaboration with both internal teams and external partners, including healthcare providers, community programs, and social service agencies, to improve patient health outcomes and overall well-being.

Qualifications

Required Education and Experience:

• Associate’s degree in health and human services or related field, or more than two years of experience working in Health & Human Services.
• Bilingual in English and Spanish
• Excellent oral and written communication skills
• Experience in care coordination and/or case management
  
  

Preferred Education And Experience

• Experience working with Limited English Proficient populations
• Experience working with people living with HIV and other Chronic Conditions
• Local knowledge about and connections to community health care and social welfare resources
• Highly organized with the ability to keep accurate notes and records
• Core values consistent with a patient- and family-centered approach to care
• Working knowledge of electronic health records
• Experience working in a dynamic and fast-paced team environment
• Experience working in multi-disciplinary teams
  
  

Required Skills/Abilities/Certifications/Licenses

• Proficiency with Microsoft Office; advanced skills in Microsoft Excel
• Excellent organizational and communication (verbal and written) skills.
• Proficiency with Electronic Medical Records (EMR)
  
  

Preferred Skills/Abilities/Certifications/Licenses

• Project Management Certificate
• Certified Health Education Specialist
  
  

Duties And Responsibilities

• Implement Action Plans for patients assigned to case management. Services may include:
• Managing a high volume of caseloads that include proactive outreach and documentation of encounters.
• Scheduling appointments and providing telephonic reminders of appointments.
• Assist the individual in navigating health, behavioral health, and social services systems, including housing as needed.
• Telephonic outreach and follow-up to individuals who do not require face-to-face contact.
• Administer Health Related Social Needs Screening (PRAPARE) as required.
• Ensure accurate and consistent documentation of services in EMR
• Troubleshoot medication access, including filling out forms, submitting to appropriate channels, and contacting pharmacies.
• Assist with arrangements such as transportation for patients with complex needs.
• Obtain missing records and consultation reports.
• Encourage the individual’s decision-making and participation in the action plan by developing SMART Goals.
• Ensure that the individual connects to systems of eligibility for public benefits, including Medicaid.
• Ensure patient-centered approaches to build rapport to help patients address health-related social needs.
• Provide individual and family support in identifying and meeting their range of biopsychosocial needs and accessing resources. These services include, but are not limited to, medical transportation, language interpretation, appropriate literacy materials, housing assistance, food access and other community resources.
• Provide referrals to community and social support to connect clients with referrals to a wide array of support services that will help them overcome access or service barriers, increase self-management skills, and achieve overall health outcomes.
• Provide benefits counseling and support to assist eligible clients in obtaining access to public and private programs for which they may be eligible, including but not limited to AIDS Drug Assistance Program, Pharmaceutical Manufacturer’s Patient Assistance Programs, other state or local health care and supportive services.
• Work with the Team Lead and other Case Managers to ensure a successful monthly transition of pending items on caseloads.
• Follow all protocols and procedures required by funders and by La Clinica del Pueblo regarding care coordination duties and responsibilities.
• Demonstrate professional, appropriate, effective, and tactful communication skills, including written, verbal, and nonverbal.
• Demonstrate a positive attitude and respectful, professional customer service.
• Acknowledge patient’s rights on confidentiality issues, always maintain patient confidentiality, and follow HIPAA guidelines and regulations.
• Proactively act as patient advocate, responding with empathy and respect to resolve patient and family concerns, and recognizing opportunities for improvement to meeting patient concerns.
• Proactively continue to educate self on providing quality care and improving professional skills.
• Maintain medical records including completeness, filing, neatness, confidentiality, and documentation.
• Attend required internal and external program meetings.
• Complete monthly reports assigned.
• Meet with supervisor as required.
• Provide other activities as identified by your supervisor.
  
  

Supervisory Responsibilities : N/A

Physical Requirements

Prolonged periods of sitting at a desk and working on a computer