Rep Payee Case Manager

Summary:

This position follows a minimum of 80 Rep Payee clients; involves coordination of inpatient and outpatient medical care with the ultimate goal of promoting and supporting independence and self-sufficiency. Following a referral by the LSS Rep Payee Financial Coordinator, the case manager will provide comprehensive case management services. Case management services may include:  patient intake, assessment of needs, service planning, service plan implementation, service coordination, monitoring and follow-up, reassessment, treatment adherence, case conferencing, crisis intervention, and case closure.   

Specific responsibilities are demonstrated within the following (5) areas:

 Client Assessment

• Conducts comprehensive needs assessment of clients to determine the client’s current health states and risk factors.
• Level of adherence to prescribed medications, nutritional status, housing arrangement, history of substance abuse, literacy level, access to transportation, network of social support.
• Determine the ability to manage finances and the need for assistance to perform daily living activities.
• Conducts home visits as needed to ensure timely access to and coordination of medical and psychosocial services.
• Assess client stability and provide referrals to increase level of stability and self- sufficiency.

Individualized Service Plan (ISP)

• Ensure that the client is an active stakeholder in his/her own care to develop an ISP that will establish objectives and desired outcomes as well as identify the action items needed to achieve them.

• Action items may include referrals and referral follow-ups, doctors’ appointments, home visits and application for all entitled benefits.
• Develop an ISP that will provide structure for the client’s care and monitor progress toward the stated goals.
• ISP will be re-evaluated once every six months and is written to be a “living document” that can be revised at any            point to ensure it continues to address the clients’ unique evolving needs.
• Identifies and develops a family support plan and discharge plan on an ongoing basis.
• Engages a medical consult with the attending physician for each client every six months.

 Counseling, Support and Education:

• Serves as advocate, caretaker, listener, encourager, enforcer at least once per month.  

• Educates, links and refers clients to follow-up on all medical care and provide community resources to address client needs.  
• Advocates for client’s unmet needs, providing clinical intervention (counseling, support) as needed.
• Is familiar with appropriate sources of referral for mental health, substance abuse, home care, food, transportation and other support services.
• Aids with insurance issues, Medicaid, Medicare, and other public assistance services.
• Develop therapeutic relationships with clients, maintain ongoing connection with clients and families during times they are not accessing services.
• Assure client awareness of all Lutheran Social Services programs and available community services; advocate for accessibility for all services.

 Service Referral:

• Works collaboratively with network and community agencies to ensure comprehensive care for clients.

• Provide linkages to agency, community, and government services and monitor referral completion, including state insurance continuation programs, medication patient assistance programs (PAP), benefits/health coverage programs such as SSI, SSDI, Medicaid, Medicare, housing programs, etc.
• Coordinating, referring, and linking clients with additional services, e.g., housing support, substance abuse and mental health treatment, food services, etc., as needed;
• Authorizes transportation for clients or provides transportation as necessary for the client to receive medical services and other social aid services as needed.

Administrative:

• Case Manager will communicate with each client monthly. At least once every six months, the client and the case Manager will meet in person to re-evaluate the ISP and make any necessary changes.
• Case Manager will keep detailed notes of all client interactions, progress notes, other required information reporting as defined by agency standards, and will document all referrals and referral follow-ups.
• Case Managers will close all cases in a timely manner so new clients may be enrolled from the waitlist.
• Case Manager will report monthly to the Executive Director and Rep Payee Director on current cases, client progress and status, the status of the waitlist, and the cases under review for closure.
• Attends weekly/monthly clinical staffing/case conferencing, providing input regarding patient medical case management needs.  Attends other agency, staff, and other meetings as required.
• Attends educational activities, trainings, and events as required. 
• All other duties as assigned.

EDUCATION, CERTIFICATION, LICENSURE (Required/Preferred)

Required:

• 4-year BS/BA degree in sociology or other related field required, or 2-year ASN/nursing degree acceptable

 Skills:

• Good clinical knowledge of human behavior. Good interpersonal skills.
• Demonstrates a positive attitude when dealing with patients/staff.
• Must have excellent organizational skills. Ability to prioritize work and handle multiple tasks. 
• Working knowledge of computers and computer software such as MS Word, Excel, and Outlook.
• Must be able to communicate orally and in writing.  Maintains patient confidentiality. 
• Must be very detail-oriented and capable of thinking independently while exercising good judgment. Required to make independent judgments without supervision. 
• Must be able to generalize, evaluate, or make decisions based on sensory or judgmental criteria.
• Must be able to perform under stress when confronted with emergency, critical, or unusual situations. 
• Must be capable of dealing with periodic cyclical workload pressures and levels of responsibility.  
• Requires the ability to work with people beyond giving and receiving instructions
• Possess and maintain a valid driver’s license and auto insurance; must be able to transport clients to various locations by using own transportation.

Experience:

Required:

• Minimum 1-2 years of case management, social work, or equivalent health-related experience
• Screening required for this position: a Level 2 background check (company paid through the Background Clearinghouse - https://info.flclearinghouse.com), a drug screen (company paid), and a driver's license check (company paid) - all at time of job offer

Preferred:

• Minimum 1-2 years’ experience with high-risk population preferred
• Organization
• Cultural Competency
• Listening
• Problem Solving
• Teamwork
• Leadership
• Communication
• Decision Making
• Customer Service
• Computer Literacy
• Knowledge/Learning
• Self-Management
• Responsibility
• Professionalism/Integrity

REQUIRED JOB COMPETENCIES (Behaviors - For Effective Job Performance)

WORK ENVIRONMENT/PHYSICAL DEMANDS:

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Activity:

(if more than 2+ hours per day)

 Standing, sitting, mobility,  climbing   , and balancing

 writing, crawling, squatting, bending, filing, twisting

Lifting to include:

 up to 10lbs.   11-25 lbs.   26-60 lbs.   61-75 lbs.  over 75 lbs.

 pushing         pulling           carrying

Environmental Conditions:

 cold, heat, wet, and/or humid,  noisy   vibration, fumes, dust, 

 odors, mists

Sensory:

 hearing to converse, hearing to use the telephone, talking

 tasting/smelling, reading distance 1-5ft., reading distance 10-30ft.

Driving:

 incidental driver, regular driver

Keying:

 Occasionally (2-3 hours week), Frequently (2-3 hours day), Continuously (4+ days)

Safety:

lists specifics: Possible exposure to blood and bodily fluids in a clinical setting; willing to transport clients in personal vehicle