Work in cooperation as part of a multi-disciplinary team with representatives from programs in Tulare County Health and Human Services Agency, community partners, community members, landlords, and other governmental agencies to identify services to meet the client’s needs. Demonstrate flexibility, enthusiasm, and willingness to cooperate while working with others in multi-disciplinary teams with activities. Establish and maintain positive, productive working relationships with clients, client’s families, caregivers, and client’s care team. Interview and screen new and established patients to determine eligibility for health insurance and other programs, including Medi-Cal, Covered California, CalFresh, CalWORKs, CAPI, and General Assistance. Assist clients and community members with completing and submitting applications through Covered California, other benefit applications, or paperwork associate with services. Meet with clients in their homes, physician offices, County buildings, community members’ offices, street outreach, or other agreed upon public places to introduce programs, perform intake assessments, risk assessments, and get appropriate consents. Complete assessment to determine client needs and identify resources available to meet those needs. Collect Vital Documents (State ID, Birth Certificate, Social Security Card) and upload documents in various benefit applications as needed. Assist clients and service providers in collecting Verification of Disability Status or Med-9, signed by a licensed professional. Work with referring agency staff to coordinate initial client meetings and discuss program expectations. Manage a caseload involving the determination of the most complex initial and continuing eligibility criteria for more than one services in the following areas of, but not limited to: independent living skills, housing stabilization, money management, community integration, employment linkage, benefits establishment, linkage to community providers for substance abuse, primary and mental health care, health care, and all other services needed to assist clients in reaching their treatment plan goals Develop an individualized treatment plan in collaboration with clients addressing short term and long-term goals. Communicate with and provide feedback to referral sources, including physicians, advanced practice providers, behavioral health specialists, social services, employees, and care coordinators as appropriate. Follow-up with clients they have engaged with to ensure that they have connected with support structures and received the services they need. Provide on-going case management support to assess progress and ensure treatment plan outcomes are met or changed as needed. Conduct crisis and risk assessments in consultation with supervisor or multi-disciplinary team. Provide crisis intervention services focused on enhancing the client’s ability to independently problem solve, utilize effective coping skills, and manage and self-coordinate their own care. Facilitate access to services required to foster housing readiness (credit repair, legal aid, housekeeping, money management, tenant rights, and responsibilities, etc.) as needed. Provide information and instruction to clients regarding how to complete paperwork needed to obtain services. Act as the primary contact point, advocate, and source of information for clients, employees, or community members who provide assistance or care to the client. Advocate for patients with County and State Social Service agencies by helping file appeals and other actions. Serve as mediator or advocator for the client with service providers, as needed. Attend all eligibility related meetings and training. Promote awareness of behavioral health issues and the commitment to recovery, wellness, and self-help. Conduct community outreach to raise awareness of available health, behavioral health, and social services programs. Collect monthly updates from agencies on referrals sent. Maintain complete client records, daily activity logs, mileage logs, and other reports as directed. Collect and record program data into various software programs. Responsible for tracking and reporting all required data for enrollment and outreach efforts. Conduct outreach efforts to identify program participants and assist with linkage to social supports. Assist the care team by helping to measure quality and identify, refine, and implement practice improvements. Attend staff meetings, case conferences, training workshops, and community meetings as needed. Coordinate primary, behavioral, developmental, oral health, Long Term Services and Support (LTSS) and ILOS services that address social determinants of health needs. Oversight of communication with the care team that ensure safe, appropriate, and effective person-centered care. Primary liaison to support primary care needs with appropriate primary care service provider and other community services. Primary contact for managed Care Plan(contractor). Accompany member to office visits, as needed including providing transportation Distribute health education materials. Use Motivational Interviewing (MI), trauma informed care and harm-reduction approaches.

Education: Two (2) years of college courses in the Mental Health, Human Services, Social Work, Biological, Social Sciences field or related field

Experience: One (1) year of experience working in a social services program, public health program, or behavioral health program.

Equivalency for Education:

Direct program experience working with public health programs, social services program, or behavioral health program may be substituted for the educational requirement on a ratio of one (1) year of direct experience for one (1) year of college education

Knowledge of :

Knowledge of data collection practices and reporting skills. Knowledge of interviewing techniques. Basic understanding of mental health, physical health, and substance abuse issues and symptoms. Current in knowledge of social work practices and principles related to best practice standards. Knowledge of social services programs, behavioral health services, and public health services, alcohol, and drug services programs.

Skill/Ability to

Communicate and relate effectively with clients, who may be emotionally or mentally disabled, medically disabled, elderly, substance abusers, and victims of domestic violence or fiduciary abuse. Establish and maintain effective working relationships with others, including clients, family members, and others who may be under distress or duress. Operate contemporary office equipment inclusive of a computer, keyboard, and all applicable electronic equipment. Research, compile, and analyze information and prepare appropriate alternatives and recommendations. Ability to listen with sensitivity to other people’s feelings, needs, and point of view; demonstrate tact and courtesy in expressing opinions or ideas, and to recognize opportunities to enhance community relations. Ability to work in a typical office environment and in areas inhabited by homeless persons, including working in dirty environments and dealing with challenging individuals. Be able to work flexible hours. Excellent organization skills and detail-oriented; ability to manage multiple cases efficiently and effectively. Creative problem-solving skills. Ability to maintain a calm and sensitive demeanor in stressful situations. Crisis de-escalation skills. Locate, develop, and use community and agency resources for the benefit of clients and advocate for services on behalf of clients. Facilitate maximum client participation in service plans. Manage assigned caseload and establish caseload priorities to meet client needs and agency expectations. Ability to effectively present information to others, including other employees, community partners and vendors. Ability to seek direction/approval on essential matters, yet work independently with little onsite supervision, using professional judgment and diplomacy. Work in a team-oriented environment with a number of professionals with different work styles and support needs. Excellent interpersonal, verbal, and written skills. Prioritize and respond to demands of caseload in a prompt and efficient manner. Recognize and analyze problems, gather relevant information, establish facts, draw valid conclusions, respond to case details promptly, and communicate clearly and concisely both orally and in writing. Maintain current and accurate records. Learn complex regulations, policies and procedures and apply them appropriately in management of assigned caseload. Work effectively under pressure and deadlines. Exercise exceptional interpersonal skills, good judgment, and an understanding of highly complex and political environments. Demonstrate strong analytical skills, excellent communication, and presentation skills. Ability to build and maintain good working relationships with landlords and other community partners. Adjust to changes in workload, coordinate work with others and work under stress of meeting deadlines. Organize work in a step-by-step order. Establish rapport and maintain effective working relationships with others. Use patience, tact and courtesy in dealing with people under various circumstances and under emotional stress. Keep systematic and accurate records. Maintain confidentiality of all information and materials. Work under stressful situations. Complete multiple priority projects with strict deadlines. Maintain confidentiality of patient/client information. Attend meetings outside of regular working hours and may work on-call to respond to emergencies.

License/Certificates:

Conditions of Employment
Possession of, or ability to obtain, an appropriate and valid California drivers license. Candidates selected will be required to pass a pre-employment drug and alcohol screening. Additionally, a background investigation may also be conducted, which may include a re-investigation every 10 years for some positions. An Employment Eligibility Verification using E-Verify may be required on the first day of employment for some positions. Some job classes may also require a physical exam.

College Cost Reduction Access Act
This may a qualifying position for student loan forgiveness through the College Cost Reduction and Access Act (CCRAA). Only student loan payments made after October 1, 2007 and in a qualified repayment plan are eligible. For more information you are encouraged to speak with your student loan servicer or visit: https://studentaid.gov/manage-loans/forgiveness-cancellation/public-service

EQUAL OPPORTUNITY EMPLOYER