SDOH Case Manager

A SDOH Case Manager will be responsible for assisting the outpatient providers with case management support by identifying needs and providing resources to patients as well as coordinating and collaborating with CPR clinicians and third party providers.

Knowledge and Skills:

• Communication Skills: Must be comfortable engaging in conversation over the phone and in person with patients. Communication must be professional, calm, and sensitive at all times.

• Behavioral Health Skills: must possess a working knowledge of behavioral health symptoms, presentations, diagnoses and treatments. Must be able to interact with patients who are experiencing chronic or acute mental illness. This may include de-escalation and rapport building in order to obtain needed information.

• Organizational Skills: Must be able to accurately collect, store and track a large amount of patient data.

• Computer Skills: Must be able to accurately and thoroughly document in patient charts and in online portals.

• Outreach, Research and Networking Skills: Must be comfortable researching and reaching out to resources and community partners to build and maintain a functional referral source base.

Duties:

• Contact patients to determine time to complete initial Social Determinants of Health (SDOH) and Health (HRA) screenings either in person or over the phone.

• Provide information to patient on purpose for SDOH and HRA screenings.

• Collect data from identified patients using SDOH and HRA forms and enter into patient chart and/or online insurance portal as required.

• Review screenings with patient including needs.

• Provide patient with resources that are compatible with current identified needs.

• Coordinate with patient’s treatment team.

• Assist patients with needed referrals, phone calls, etc.

• Complete SDOH screen quarterly or if patient or provider identify change to patient psychosocial status or functioning.

• Provide follow up and assistance with patients as they utilize resource referrals provided to them.

• Serve as a support to clinical team to provide resources to patients who have not completed SDOH screen.

• Assist patients and clinical team with finding higher levels of care (IOP, PHP, inpatient hospitalization, residential treatment, SMI services, petitioning) for patients who present to the office with acute symptoms.

• Being flexible and willing to cover front desk duties as well as COC team duties as needed.

Qualifications and Education Requirements

• High School or GED diploma required

• 2 or more years of experience in behavioral health

• 2 year degree or some college preferred