Case Manager – High Risk Populations (Housing Support)
Central Health, Austin, TX, United States
Central Health’s High Risk Populations Department provides innovative, patient-centered care to individuals experiencing homelessness and housing instability. These programs address gaps in medical care by combining access to health services with intensive case management, emergency shelter support, and coordination of social services. This role will be expected to support one or more programs including The Bridge Program, Medical Respite, Housing Support Program, and more.
Overview
The Case Manager is a key member of a multidisciplinary team, providing intensive, trauma-informed case management to patients served through Bridge, Medical Respite, and Housing Support Programs. Case Managers are skilled in crisis management and advocacy, providing timely referrals to appropriate services while supporting patients in accessing benefits and entitlements and identifying safe, affordable housing. This role works across fixed clinic sites, mobile locations, and respite settings to promote improved health outcomes, stability, and self-sufficiency as part of a comprehensive approach to ending homelessness.
Responsibilities
Conduct whole-person assessments to determine client’s strengths, barriers, mental health needs, and readiness to change
Provide crisis intervention services (assessment, evaluation of risk, safety planning, referral, and follow up)
Develop individualized care plans in collaboration with patients that address mental health, medical, and social determinants of health
Effectively de-escalate heightened situations with patients experiencing trauma, exacerbated mental health symptoms, and behavioral complexity while using a trauma-informed care approach
Provide goal-oriented and solution-focused services and evidence-based interventions to address mental health and psychosocial needs
Educate and work collaboratively with patients on available community resources while advocating and helping to coordinate with community supports and services
Teach patients through structure and modeling appropriate expectations and guide them on following through with their tasks
Help patients identify and manage challenges or barriers in navigating their health and government benefits
Accompany patients to appointments as needed
Assist patients directly or indirectly with housing survey (Coordinated Assessment)
Work with patients on discharge planning by reviewing potential transitional housing programs, assisting with room rental search, and applications for housing units
Collaborate with housing specialists and/or other resources to identify and address psychological, social and medical needs, and coordinate referrals for housing programs
Work collaboratively and advocate with patient’s interdisciplinary team, community resources, and partner agencies
Participate in interdisciplinary case conferences to support coordinated patient care
Assist other teams within the department as needed
Complete documentation in a timely manner
Other duties as assigned
Knowledge, Skills and Abilities
High level of skill at building relationships and providing excellent patient support
High level of problem-solving skills to better serve patients and staff
Strong attention to detail and accuracy
Excellent verbal and written communication skills
Demonstrated knowledge of community resources available and how to access resources for the benefit of clients
Demonstrated success in collaborating with multidisciplinary team members
Bilingual (Spanish/English) preferred
Strong knowledge of evidenced-based practices commonly used in case management, crisis intervention, and the populations served
Strong knowledge of mental health and substance use diagnoses, trauma-informed care, patient engagement, motivational interviewing, and cultural competency
Required Education
Bachelor's degree in Social Work or related field (higher degree accepted)
Required Experience
Internship or work in field related to social work, case management, or counseling individuals in crisis/trauma situations
Demonstate knowledge of community resources available and how to access resources for the benefit of clients
Required Licenses and Certifications
Valid driver's license
Basic Life Support
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Overview
The Case Manager is a key member of a multidisciplinary team, providing intensive, trauma-informed case management to patients served through Bridge, Medical Respite, and Housing Support Programs. Case Managers are skilled in crisis management and advocacy, providing timely referrals to appropriate services while supporting patients in accessing benefits and entitlements and identifying safe, affordable housing. This role works across fixed clinic sites, mobile locations, and respite settings to promote improved health outcomes, stability, and self-sufficiency as part of a comprehensive approach to ending homelessness.
Responsibilities
Conduct whole-person assessments to determine client’s strengths, barriers, mental health needs, and readiness to change
Provide crisis intervention services (assessment, evaluation of risk, safety planning, referral, and follow up)
Develop individualized care plans in collaboration with patients that address mental health, medical, and social determinants of health
Effectively de-escalate heightened situations with patients experiencing trauma, exacerbated mental health symptoms, and behavioral complexity while using a trauma-informed care approach
Provide goal-oriented and solution-focused services and evidence-based interventions to address mental health and psychosocial needs
Educate and work collaboratively with patients on available community resources while advocating and helping to coordinate with community supports and services
Teach patients through structure and modeling appropriate expectations and guide them on following through with their tasks
Help patients identify and manage challenges or barriers in navigating their health and government benefits
Accompany patients to appointments as needed
Assist patients directly or indirectly with housing survey (Coordinated Assessment)
Work with patients on discharge planning by reviewing potential transitional housing programs, assisting with room rental search, and applications for housing units
Collaborate with housing specialists and/or other resources to identify and address psychological, social and medical needs, and coordinate referrals for housing programs
Work collaboratively and advocate with patient’s interdisciplinary team, community resources, and partner agencies
Participate in interdisciplinary case conferences to support coordinated patient care
Assist other teams within the department as needed
Complete documentation in a timely manner
Other duties as assigned
Knowledge, Skills and Abilities
High level of skill at building relationships and providing excellent patient support
High level of problem-solving skills to better serve patients and staff
Strong attention to detail and accuracy
Excellent verbal and written communication skills
Demonstrated knowledge of community resources available and how to access resources for the benefit of clients
Demonstrated success in collaborating with multidisciplinary team members
Bilingual (Spanish/English) preferred
Strong knowledge of evidenced-based practices commonly used in case management, crisis intervention, and the populations served
Strong knowledge of mental health and substance use diagnoses, trauma-informed care, patient engagement, motivational interviewing, and cultural competency
Required Education
Bachelor's degree in Social Work or related field (higher degree accepted)
Required Experience
Internship or work in field related to social work, case management, or counseling individuals in crisis/trauma situations
Demonstate knowledge of community resources available and how to access resources for the benefit of clients
Required Licenses and Certifications
Valid driver's license
Basic Life Support
#J-18808-Ljbffr