Job Description

Job Description

Job Description

Purpose: This is a full-time, grant-funded 35-hour/week position. Under the direction of the Associate Director, targeted Health Care Case Management is delivered that addresses all the domains of social determinants of health. This position is a direct service position supporting people in our public housing sites within Allegheny County toward self-sufficiency, housing stabilization and reduced risk of adverse health outcomes.

Essential Job Functions:

1. Must be able to work independently, moving ACHA residents in the direction of independence by encouraging self-determination, and self-evaluation and consistently assisting ACHA residents to recognize their own strengths and using those strengths for personal growth
2. Must demonstrate a strong work ethic and a high level of integrity
3. Provide direct services to recipients within ACHA for the purpose of outreach, intake and assessment, education, and/or referral for identified Social Determinants of Health (SDOH) needs
4. Maintain an active caseload of at least 40 individuals within the ACHA portfolio
5. Must maintain confidentiality and provide information within agency guidelines and on a need-to-know basis
6. Provide services in an empathic, hopeful, and welcoming manner
7. Complete all documentation and data collection in accordance to State and agency requirements including intake, assessments, data entry, and progress notes
8. Prepare and maintain all necessary documents for the case file and insurance provider reporting.
9. Provide education and linkage to Medical Assistance providers and support the development of living skills that will improve health outcomes
10. Enhance coordination of services for behavioral and physical health with local Medicaid insurance providers
11. Engage Community-Based Organizations as part of an integrated holistic approach to person-centered care and education
12. Work collaboratively with the CBCM Associate Director to identify interventions and resources available that increase Health literacy and reduce the risk of utilization of acute services
13. Develop and maintain a comprehensive list of local and state resources that address each domain of Social Determinants of Health, with a focus on street medicine, harm reduction and preventative screening best practices
14. Foster Cross-Departmental collaboration to help identify community-level needs and produce outcome deliverables
15. Ability to demonstrate time management, team collaboration, and professional written and verbal communication skills
16. Ability to demonstrate critical thinking and problem-solving to determine the best plan for each individual on their caseload
17. Provide quarterly and annual follow-up to ensure individuals served were satisfied with services and have maintained the resources provided
18. Communicate with other team members and program manager about resident progress and needs
19. Participate in scheduled supervisions to provide and accept feedback and identify opportunities for continued professional development
20. Develop individualized treatment plans with each resident to further develop their ability to live independently in the community
21. Obtain Advanced First Aide and CPR certification within 6 months of employment
22. Must have and maintain a valid PA driver’s license and use of a personal vehicle.

Required Education/ Experience: Bachelor’s Degree in Social Work, Psychology, Nursing, OR no degree and minimum of 4 years of demonstrated relevant experience.

Experience Preferred : Compiling and sorting date, entering raw date into database. Proficient in various programs to include, but not limited to: Microsoft Outlook, Word, and Excel. Demonstrated knowledge and experience in the provision of community social services, insurance benefit navigation and continuum services of care.

Physical Requirements: Work is performed both in office settings and community settings. Must be physically able to access various physical locations on and off ACHA. Must have a level of manual dexterity sufficient to allow for the operation of a computer, telephone, fax machine, calculator, etc. Ability to move, handle or lift small objects around desk area, i.e. files, computer printouts, reports, calculator, office supplies, etc.

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