• Bilingual in English/Spanish

As an LVN Case Manager in our Enhanced Care Management (ECM) department, you will provide case management and healthcare services to diverse clients, including high service utilizers, individuals and families experiencing homelessness, adults with serious mental illness or substance use disorders, and those transitioning from incarceration. Your primary responsibilities will include conducting assessments, developing care plans, and coordinating medical services for individuals experiencing homelessness.  

• Collaborates with ECM Staff, Providers, Managed Care Plans, Housing Navigation Team, and community homeless service providers to offer enhanced care coordination for eligible patients and/or entities, ensuring a seamless experience for the patient and avoiding duplication of services.


• Conducts case management services, including intake and assessment (functional, psychosocial, housing, mental health, and substance use). Develops a comprehensive care plan based on the assessment with measurable goals, interventions, and objectives to effectively implement the care plan. Includes subspecialty referrals, regular monitoring of the care plan, and necessary follow-ups.


• Connects Members to other social services/support services and provides appropriate referrals for subspecialty care (e.g., ophthalmology, behavioral health, podiatry, nutrition), transportation, food, and housing. Accompanies Members to office visits, as needed.


• Provides health education as needed based on the patient's requirements and follows up on compliance issues, especially with medication management, blood sugar, blood pressure, etc.


• Utilizes motivational interviewing, trauma-informed care, and harm-reduction approaches.


• Coordinates with hospital staff on discharge plans.


• Collects and enters necessary data for reporting purposes. Completes and submits monthly project activity and other reports as assigned for submission to the funding source.


• Participates in agency and community meetings related to the needs of patients and issues related to Case Management diseases.


• Attends weekly case conferences with PCP’s clinical supervisor and peers to assist in problem-solving related to clients and ensure the provision of professional guidance and high-quality case management services.

We're committed to ensuring our team members are well taken care of. Our benefits package includes medical, dental, and vision coverage, sick leave, vacation time, 13 paid holidays, a 401(k) Safe Harbor Profit Sharing plan, mileage reimbursement, short-term and long-term disability plans, life insurance policies, employee parking, and more.