Social Worker- hybrid

We are hiring for 2 full time temps to work hybrid for 3 - 6+ months in SF. Caseload is 30 - 35, home visits are required, public transport is fine (reimbursable), if you use a car they will reimburse for mileage. Documentation is done at home so half in the field and half remote. The Care Manager provides intensive case management services for clients with multiple medical and psychosocial needs who are at risk of homelessness. In coordination with APS staff, provides housing-related assistance to reduce eviction risk and increase housing stability.

RESPONSIBILITIES:

· Provides intensive case management services to clients who are at risk of homelessness and who have a history of or ongoing self-neglect.

· Conducts home visits, visits to clients at acute hospitals, residential care facilities, and skilled nursing facilities. Escorts clients to medical and other appointments as clinically indicated.

· Participates in cross-collaboration with APS and other community partners, taking a client-centered, trauma-informed, and harm-reduction approach. Demonstrates professionalism and establishes positive relationships with social service providers involved in client care.

· Assesses appropriate level of care for clients and facilitates transition to alternative placement as indicated. Collaborates with various housing agencies to support client community stability and adheres to the principles of the “Housing First” approach.

· Documents via progress notes all case management activity regarding identified problems within 24-48 hours, adding any new problems to the care plan, as needed.

· Completes comprehensive assessments and ongoing re-assessment of the client to evaluate bio-psycho-social needs and risk of homelessness. Based on assessment information develops and initiates the plan of services, which is client-centered and consistent with program guidelines and policies and procedures.

-· Establishes and cultivates mutually respectful and inclusive relationships with clients, staff members, colleagues and community partners.

· Provides culturally responsive services to support clients’ engagement, understands how trauma and other psychosocial factors might influence clients’ participation in social services and care

· Actively assesses and responds to a variety of situations that may include crisis intervention and conflict resolution.

· Meets with clients at least monthly, and more often as clinically indicated. Reviews and modifies their plan of services on an ongoing basis.

· Evaluates client for Purchase of Service needs through flexible financial support that promotes safety and house stability.

· Attends continuing education classes and/or in-service training to increase knowledge, skills and attitudes related to case management, gerontology, family and community systems and other areas relevant to the client population.

· Shows initiative in identifying alternative long-term funding resources for housing, such as through community housing stipends, Assisted Living Waiver (ALW), or other resources offered through the regional homelessness continuum of care.

· Engages in program development discussions and related projects, including providing support to team around preparation of reports and audits

· Supports development of Policy & Procedure Manual and collaborates with leadership on annual review and revision of manual.

· Establishes and maintains a care management relationship with clients and their informal support network as appropriate, offering respect, dignity and support. Provides equitable and culturally responsive crisis intervention, advocacy, problem solving, and other services.

· Identifies, arranges for, and monitors appropriate community services based on a good knowledge of Medicare, Medi-Cal, and other entitlement programs.

· Documents via progress notes all case management activity regarding identified problems within 24-48 hours, adding any new problems to the plan of services, as needed.

· Maintains required written documentation and follows a clear, concise, and consistent system of charting to allow for continuity of care. Maintains client files according to company policy and contract requirements.

· Educates clients and informal support network about resources.

· Completes charts, case terminations and other documentation requirements within deadlines.

· Establishes and maintains open and effective communication with community providers, including physicians and other health care and social service workers. Provides appropriate information on all significant aspects of individual client care and program operations, while maintaining necessary confidentiality.

· Monitors the quantity and quality of the services provided by other involved providers.

· Working closely with the team, continuously evaluates the clients’ ability to remain safely at home; coordinates placement as appropriate, according to program guidelines.

· In collaboration with the client, caregiver, and involved services, terminates clients when appropriate. Documents the process as required.

· Participates in and promotes ongoing efforts towards Continuous Quality Improvement.

· Utilizes supervision appropriately; maintaining open lines of communication and providing updates on caseload activity.

Qualifications:

-MSW/ MA Psych

-2 years of case management experience with co-occurring disorders, mental health, at risk of homelessness, substance use, medically at risk

-home visit experience