San Bernardino, ECM Care Manager, Behavioral Health v3

Who We Are: SAC Health empowers our patients and their families to live vibrant and healthy lives through culturally responsive, exceptional care. Patient-centered, whole-person care. Our unique, full scope, team-based approach is what makes SAC Health the provider of choice for patients. Top-Tier Patient Satisfaction Scores | Largest Teaching Health Center FQHC | 11 Locations offering 44 Specialties | Participation in NHSC & NCLRP loan forgiveness programs What We Are Looking For As a member of the Care Management Team, the ECM Care Manager, Behavioral Health (ECMCMBH) is responsible for the clinical coordination of moderate to high-risk patients, such as, but not limited to, homelessness, chronic medical, behavioral, substance use health conditions, social determinates of health issues, children and/or youth, and individuals with post-incarceration. The ECMCMBH works collaboratively within an interdisciplinary care team to improve the health and wellbeing of patients enrolled in the Care Management Team. The ECMCMBH will provide brief behavioral therapeutic interventions and linkages to community resources and education on chronic medical and behavioral health conditions. Utilizing evidence-based approaches, the ECMCMBH will promote ongoing engagement with patients and work collaboratively with practitioners across the healthcare spectrum to provide integrated care management services to moderate to high-risk patients. The ECMCMBH will be responsible for crisis evaluation and intervention for patients within the Care Management Team. Individuals with ACSW licensure may work within the scope of practice allowed and will be provided clinical supervision. Schedule : 5 days per week, 8 hours per day, Monday - Friday 730am -4pm 30min Lunch | Location : SBC Clinic, San Bernardino, CA ESSENTIAL FUNCTIONS AND DELIVERABLES Provide intensive case management for a set caseload of patients with complex behavioral and medical needs. Manage both acute and chronic behavioral/mental health diseases; Reevaluate psychosocial plan of care and ensure continued appropriateness based on the patient's changing needs and condition. Conduct initial screening assessments. Conduct ongoing behavioral health and psychosocial assessments. Provide recommendations based on assessment of patients. Monitor for warning signs of decompensation and crisis and respond accordingly. Work cohesively with interdisciplinary care team as well as health care practitioners across the continuum. Actively participate in the outreach and engagement of new patients. Promote programs to patients, families, and staff to build a patient base. Meet daily, weekly and/or monthly productivity expectations set by management. Prepare and present systematic case reviews in collaboration with interdisciplinary team. Ability to manage multiple assignments effectively; compose written material; organize and prioritize workload; work well under pressure; problem solve; recall information with accuracy; pay close attention to detail. Ensure the implementation and compliance of patient care as per provider's order. Work with patients to identify health/wellness goals and incorporate these goals into a shared care plan that facilitates communication among patients and providers. Provide Patients, Family, and Caregiver Individual Health Education on Disease Process. Elements of the health education process include verbal and written hand-outs for their reference. Required to make patient home visits as necessary; must have a reliable vehicle, valid driver's license, and auto insurance. Other duties as outlined in the official job description. QUALIFICATIONS: Education: A Master's Degree in Social Work (MSW) or related field of study is required. Licensure/Certification: Must have a valid CA Driver's License and Auto Insurance. ACSW is highly preferred. Current CPR/BLS certification (must be American Heart Association or Red Cross accredited program). As a requirement of this position, you must receive EPIC certification for the module you have been hired into. Experience: 1+ years of experience providing case management and mental health services in a community setting with homeless and/or at-risk population is highly preferred. Essential Technical/Motor Skills: Must be proficient in MS Office Suite (Word, Excel, PowerPoint, Outlook). Must be able to use widely support internet browsers. Must have the ability to use variations of electronic health records and other various databases. Interpersonal Skills: The ability to communicate positively and effectively with all staff in a multidisciplinary environment. Ability to conduct meetings and present in a public forum. Strong interpersonal relations skills. Fluency in English and Spanish preferred. Ability to maintain a professional attitude in difficult situations and communicate effectively. Understands needs of clinic and works well in a team environment. Essential Mental Abilities: Must be flexible to perform a variety of tasks. Must be well organized and a self-starter. Must have strong analytical and problem-solving skills. Work Eligibility: Must be legally authorized to work in the United States on a full-time basis. Must not now or in the future require sponsorship for employment visas. EEO : SAC Health is committed to fostering a diverse, equitable and inclusive work environment and is committed to being an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status. Full Benefits Package! Industry Leading PTO Accrual (accrued per pay period) | Sick Leave | Paid Holidays | Paid Jury Duty, Bereavemen t | SAC Health Covers approximately 85% of Team Member health premium costs (may vary w/benefit plan selection) | Retirement - up to 8% employer contribution | Continuing Education and Learning Benefits | Annual Mission Trip and much more! Learn More About the Work We Do: SAC Health's Mission: SAC Health's mission is to reflect the healing ministry & love of Jesus Christ through healthcare, education & partnerships that empower our communities to flourish. SAC Health's Core Values: Quality Healthcare - Teamwork - Wholeness -Integrity - Compassion - Excellence - Humble Service - Respect