Clinical Case Manager

About the role

This role is embedded within a close-knit community that is passionate about transforming care for individuals with complex needs through shared commitment and mutual support. You will own the primary point of contact status for assigned clients, partnering directly with healthcare providers and support services to ensure care is coordinated, aligned, and comprehensive. In this position, you will manage full client cases, coordinating health care benefits while providing education and facilitating timely access to care in a cost-effective manner. You will advocate for wellness, recovery, independence, resilience, and member empowerment, ensuring that each individual can make profound daily contributions through their care journey. Utilizing evidence-based practices such as Motivational Interviewing, Harm Reduction, and Trauma-Informed Care, you will guide meaningful engagement and support. This hybrid role requires travel up to five days per week within a designated territory and demands a reliable presence to fulfill client needs. You will play a critical part in the success of the care team, maintaining the highest standards of service delivery every day.

Key facts

What you'll do

• Assess member needs across physical health, mental health, substance use disorder, oral health, palliative care, memory care, trauma-informed care, social supports, housing, and referral linkage to community-based services.
• Oversee the development of client care plans and the establishment of measurable goal settings in collaboration with the care team.
• Deliver services where the member resides, seeks care, or finds most accessible, including office-based, telehealth, or field-based service models.
• Connect clients to necessary social services and community supports that address broader determinants of health and well-being.
• Act as an advocate on behalf of the client when interacting with health care professionals such as primary care providers and specialty clinicians.
• Apply evidence-based practices consistently, including Motivational Interviewing, Harm Reduction, and Trauma-Informed Care principles in all interventions.
• Conduct proactive outreach and engagement activities to facilitate linkage to the ECM program while meticulously logging all activities in the Client Relationship Management system.
• Evaluate client progress on an ongoing basis and update SMART goals to reflect changes in needs, response to services, and desired outcomes.
• Promote mental health through education, support, and resource navigation that strengthens coping skills and resilience.
• Arrange transportation services, such as ACCESS, to ensure reliable and timely access to necessary appointments and community resources.
• Complete all required documentation, including outcome measures, within the strict timeframes established by individual care plans and regulatory standards.
• Maintain up-to-date patient health records within the Electronic Medical Record system and other relevant business systems to ensure accuracy and compliance.
• Complete monthly reporting to verify program compliance and support continuous quality improvement initiatives.
• Attend all assigned training sessions to remain current on best practices, policies, and emerging needs within the care environment.

Requirements

• Hold a current, active California Licensed Vocational Nurse license as a non-negotiable requirement for practice.
• Be willing and able to work Monday through Friday from 8:30am to 5:00pm, balancing both in-field and remote responsibilities effectively.
• Bring a minimum of two years of experience in care management, care navigation, or community health work focused on supporting vulnerable populations.
• Demonstrate bilingual capability in Spanish and English, as this skill is preferred for effective communication and care coordination.
• Possess a working knowledge of government and community resources related to social determinants of health to guide client navigation.
• Show excellence in oral and written communication skills to convey information clearly and professionally with diverse stakeholders.
• Exhibit positive interpersonal skills that foster trust, respect, and collaboration with clients, families, and team members.
• Hold a valid driver's license and maintain reliable transportation to support travel requirements throughout the service area.
• Have general computer skills and a functional working knowledge of Google Workspace, MS Office, and standard internet applications.
• Meet all employment eligibility requirements, including compliance with federal law for identity and work verification using E-Verify upon hire.
• Successfully pass a background check, which may include a drug test or other health screenings as determined by the role requirements.

Nice to have

• Bilingual proficiency in Spanish and English is preferred for broader community engagement.
• Familiarity with government and community resources related to social determinants of health is advantageous.

Practical notes

This position may require travel up to five days per week within the San Diego area. Candidates must reside within 25 miles of the assigned territory due to the frequency of travel demands. The hiring process includes applying, followed by a phone screen, online assessment(s), interview(s), an offer, and background/reference checks. Vaccination against influenza is required for employees in client-facing roles, with requests for religious or medical accommodations considered on a case-by-case basis.