Position: Case Manager
Hours: Full Time (1 FTE)
Supervised by: Case Manager Supervisor
Location: Silicon Valley Independent Living Center (SVILC) San Jose
Summary: Perform all components of services related to SVILC’s participation in the Community Transition Program (CTP), the Office of Supportive Housing’s Temporary Housing Program (OSH), and APS Home Safe Program (HS). Under the direction of the Director of Programs, and direct supervision of the Case Manager Supervisor. the Case Manager is responsible for CTP, OSH and/or HS program development, budgeting and planning, development of annual goals and objectives, and monitoring the implementation of required federal, state, and private grants and reports. Case Managers facilitate service coordination for those individuals who choose to relocate from an inpatient facility to community living, those individuals referred by Adult Protective Services for Home Safe support and assistance to maintain their personal housing and safety, and those referred by the Office of Supportive Housing for temporary housing and case management support in motel units while awaiting long-term housing placement.
- Case Mangers, in cooperation with the CTP nurse consultant, facility discharge planning staff, regional transition team, and waiver intake staff, are responsible for linking the individual to all necessary services and supports and for ensuring that all services and supports are in place prior to discharge to housing in the community. The Case Manager will also assume the lead on post-discharge service coordination for 1 year.
- Case Managers, in conjunction with APS social workers and other Home Safe partners, facilitate the assessment and service coordination needs for elders and dependent persons with disabilities who are at-risk for institutionalization or homelessness due to neglect, unsafe housing, or abuse.
- Case Managers, in conjunction with OSH homeless services managers and Temporary Housing partners (e.g., Abode Services), facilitate the assessment and service coordination needs for homeless persons with disabilities who have scored high on the VI-SPDAT in HMIS, and are nearing placement in Permanent Supportive Housing or Rapid Re-housing with long-term supports.
- Perform related services in compliance with the Community Transition Program, according to the guidelines, rules, and regulations, established by SVILC through participation in the Money Follows the Person/CCT project as set forth by CA Department of Health Services.
- Assess Home Safe participants for level of intervention/priorities using the PR-VI-SPDAT, IADL Assessment checklist and Safety at Home checklist.
- Enter data into the SCC HMIS or other project established MIS.
- Establish ILS and safety Goal(s) with each consumer-participant.
- Work directly with nursing facility residents, their families, physicians, service providers, APS Home Safe and OSH partners to develop a comprehensive service plan for transitioning and home safety intervention purposes.
- Complete Treatment Authorization Requests (TARs) through Medi-Cal as required (CCT Program).
- Complete an ILP with each consumer that includes short and long term goals and activities.
- Establish and maintain working relationships with APS and Office of Supportive Housing providers, nursing facility and hospital staff, Long-Term Care Ombudsmen staff and volunteers, multiple community health and social services agency staff, county Medi-Cal eligibility staff, state and federal agency staff (e.g., Social Security Administration), regional centers and providers of medical and social supports, demonstration project team, and others.
- Utilize team resources to create linkages between inpatient facility residents and services, supports, agencies, housing, income, and additional resources necessary to move from the inpatient facility to a safe and supportive community environment.
- Coordinate the date of discharge from the inpatient facility with the various programs and services, including Medi-Cal eligibility, in the community setting.
- Maintain accurate, comprehensive and confidential case records.
- Coordinate referral and assessment by agencies that provide medical and social services, income maintenance, Medi-Cal eligibility, housing, modification of the home environment, transportation, and others as appropriate for preliminary care-planning for services in a community setting.
- Assist consumers with paperwork, deadlines and record keeping.
- Schedule meetings and consultations with individuals, groups or agencies that can provide input regarding preliminary care coordination for a specific resident.
- Furnish information directly to resident to determine preferences and keep them apprised of the coordination progress.
- Coordinate (but not provide) transportation, if necessary.
- Coordinate starting and ending dates of services.
- Coordinate changes with Medi-Cal eligibility aid code in the community (CCT Program).
- Assist with paperwork to re-engage residents to their income support, depending on residents’ own income source(s).
- Arrange visits, making phone calls and running errands, as necessary, for service coordination.
- Make revisions and finalizing comprehensive service plans based on residents’ stated preferences.
- Submit, on a regular basis, appropriate reports and recommendations relative to the various program effectiveness to the Director of Programs
- Represent SVILC in the community as required;
- Assist with the oversight of timely and appropriate data collection, evaluation, and reporting as required;
- Maintain records of service provision through data input into CILSuite, i.e. case notes, ILPs/Goals, outreach activities, etc.
- Evaluate the quality of service provided to SVILC consumers;
- Serve as an individual and systems advocate for Consumers.
- Travel as needed to complete case management
- Provide all four IL core services as needed and perform other duties as assigned.
- Communicate professionally and personally with the general public and professionals in a variety of arenas such as health care, social services, income maintenance, housing, and others.
- Exercise diplomacy, tact and good judgment.
- Schedule and carry out preference Interviews and conferences with residents and their significant others.
- Exercise residents’ rights to privacy and adherence to HIPAA guidelines.
- Observe and document details relative to a resident’s needs and preferences for services and service providers.
- Demonstrate excellent oral and written communication skills.
- Demonstrate knowledge of and working experience with community-based organizations, and long-term care programs, policies, and financing in the regional area.
- Demonstrate knowledge and insight to working with elders and persons with disabilities.
- Market demonstration services and supports to facilities, families, residents and interested persons.
- Keep individual service coordination records and reports.
Ideally, candidates will have life and work experience with long-term care programs, home and community-based services and programs serving seniors and/or persons with disabilities.
Educational requirements are:
- BA or BS in gerontology, social work, psychology, occupational therapy, liberal arts, or any similar health and human services area or AA with a minimum of 2 years-experience in social services work.
Preference may be given to candidates with specific experience with:
- MA or MS in gerontology, social work, psychology, occupational therapy, liberal arts, or any similar health and human services area.
- Programs serving seniors who have mental, physical and/or functional impairments.
- Programs and services for older adults who have disabilities.
- Medi-Cal and/or Medicare and individuals on Supplemental Security Income/State Supplemental Payment (SSI/SSP).
- Needs and services for dependent adults.
- Independent living skills.
- Mental health programs and services.
- Programs/services for persons with disabilities.
- Long-term care services in the home or community setting.
- Planning or arranging affordable housing programs.
- Assessing need for and coordinating medical, social and supportive services.
- Inpatient facility discharge planning.
- Information about and referral to health and social services programs, Care and service planning, specifically in the home setting.
- Personal experience with disability.
- Bilingual in Spanish or another threshold language in SCC.
Significant amount of work in the community with consumers and social workers
Sitting for long periods of time
Using computer monitor and keyboards, as well as a telephone headset, for long periods of time
Travel to various community offices and sites as necessary
Make outreach visits to locations where individuals with disabilities may be contacted
Attend various outreach and community education events
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
SVILC does not discriminate against employees or potential employees and is an equal opportunity employer with regard to the gender, age, disability, ethnicity, race, religious beliefs, gender identity or sexual orientation of individuals.
Hourly Wage Range: $22-$24/hr. (35-hour Mon-Fri workweek)
Health & Dental Benefits: 100% paid Platinum 90 Kaiser Plan and 100% paid dental plan
Paid Time Off Benefits: 12 paid holidays, 22 days paid vacation annually, 49 hours of paid sick leave annually, 21 hours of personal or development time
Vanguard 401K Plan: employee contribution only
SVILC is an Equal Opportunity Employer. People with disabilities, members of other marginalized communities, and those with personal experience with disability are highly encouraged to apply.
When applying, please note that you saw the job posted on the NOVAworks Job Board. If you need help with your resumé, please see a NOVAworks Career Advisor.