Job description

INTRODUCTION:

Central Neighborhood Health Foundation is a Federally Qualified Healthcare Center committed to the Triple Aim as described by the Institute for Healthcare Improvement.

Improving the US Health Care System requires simultaneous pursuit of three aims: 1) improving the experience of care, 2) improving the health of populations and 3) reducing per capita costs of health care. Preconditions for this include the enrollment of an identified population, a commitment to universality for its members, and the existence of an organization (an "integrator") that accepts responsibility for all three aims for that population.

SUMMARY

Enhanced Care Management (ECM) benefit is a new, statewide benefit established by the Department of Health Care Services (DHCS) to provide a whole-person approach to care that addresses the clinical and non-clinical circumstances of high-need Medi-Cal beneficiaries enrolled in Medi-Cal managed care. Enhanced care management is a collaborative and interdisciplinary approach to providing intensive and comprehensive care management services to populations of focus.

The following seven core services will be provided at the point of care:

1. Outreach and engagement.

2. Comprehensive assessment and care management plan.

3. Enhanced care coordination.

4. Health promotion.

5. Comprehensive transitional care.

6. Member and family supports.

7. Coordination of and referral to community and social support services

ECM population of focus

1. Individuals and families experiencing homelessness

2. High utilizer adults

3. Adults with serious mental illness (SMI) or substance use disorder (SUD)

4. Adults and children/youth transitioning from incarceration

Role

• Responsible for ensuring clinical assessment elements leading to the creation of the plan of care are under the direction of an independently licensed clinician.
• Review and inform the care team.
• Act as clinical resource for care team, as needed.
• Facilitate access to primary care and behavioral health providers, as needed to assist care coordinator and team

QUALIFICATIONS

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

EDUCATION and/or EXPERIENCE

• California license as a Registered Nurse or LCSW
• Must be sensitive to the needs of the patients in a community health care setting in the areas of health and social services as one component.
• Bilingual in English/Spanish is desirable but not necessary.

WORK ENVIRONMENT

Described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions. Variations in conditions may occur under certain circumstances.

Job Type: Full-time

Pay: $90,000.00 - $105,000.00 per year

Benefits:

• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Retirement plan
• Vision insurance

Schedule:

• 8 hour shift
• Monday to Friday

Language:

• Spanish (Preferred)

License/Certification:

• Licensed Clinical Social Worker (Preferred)

Work Location: In person

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