Careers

Case Management Specialist

Will provide comprehensive case management activities for elders, disabled adults, and their families

Job Description:

Under the general supervision of the Elderly Services Program Director, the incumbent will provide comprehensive case management activities for elders, disabled adults, and their families to improve their quality of life and provide access to resources both locally and regionally to maintain the highest level of functionality so clients may age in place within the community. Incumbent must effectively interpret program services and perform tasks directly related to community elder clients (aged 50 years and older).  Services will focus on the enhancement and improvement of the daily lifestyles of the elder population. Incumbent will be required to develop care plans for respective clients to address individual needs and supports. Interpret a variety of service reports and data bases (i.e. SAM’s, OAAPS, etc.) to ensure that all service needs are delivered and recorded. Incumbent will be required to work with other program staff and organizational programs in capturing and recording data and information related to elder clients, their stated needs, and in the planning and scheduling of case management activities. Incumbent will also be responsible for implementing Family Caregiver activities, events, and responsibilities to ensure that both the client and the caregiver are supported. The position requires a high level of visibility within the community which requires excellent communication and interpersonal skills which are vital in maintaining a rapport with community elders, the general public, and agencies providing services. Incumbent’s contacts will include but are not limited to Tribal Council, Tribal Administration, Tribal Programs staff, Federal, State, and County agency representatives, elders of the community, and the general public.

Duites:

1. Facilitates client access to community and agency resources including but not limited to activities and services to establish social support networks, meet individual client needs to address emotional/mental health wellbeing;
2. Assists clients and families in developing goals and care plans in areas of identified client needs. This includes providing interpretation, guidance and preparation for assistance/support applications. Conducts regular follow up to ensure goals are met and care plans are followed.
3. Organize, facilitate and evaluate service delivery/care plans while conveying information and options which best meet the client’s mental, physical, and emotional well-being.
4. In collaboration with other elderly services program staff, participates in conducting initial assessments/intake for new clients, annual 12 month and 6 month re-assessments for enrolled clients to ensure regular updates on client information and care plans.
5. Prepare notes for client files to ensure that delivered services and supports are properly documented and recorded.
6. Provide direct supervision to the Data Entry Clerk/Outreach Worker position to ensure compliance with organizational policies and procedures and to ensure that staff member is sufficiently fulling the duties and responsibilities of their position.
7. Enter service data into the SAMS/Harmony data base to ensure all services data is entered properly. Review data of entered by the Outreach Worker/Data Entry Clerk to ensure the accuracy of the entered units of service.
8. Conduct regular in-person congregate setting and home visits with clients to ensure their needs are being met, to ensure proper communication, and to ensure that they feel safe and supported.
9. Advocate for elder clients to ensure they receive the appropriate services and support.
10. Educate elder clients and their families on available resources, services, and support options. Assist clients in making informed decisions through advocacy and information.
11. Documents all client encounters, and contacts made on behalf the client(s) and program to ensure proper documentation of case related information.
12. Maintain comprehensive client files which includes management of formal and confidential documents held for safe keeping on behalf of the client.  Respond to information access and retrieval requests from authorized individuals following all stated confidentiality guidelines.
13. In collaboration with other program staff, incumbent will plan and organize promotional activities to include but not limited to public education, group presentations, health fair participation, and development and dissemination of flyers, brochures, and newsletters.
14. Determines client needs through target assessments and works with program staff and other resources to plan/coordinate care and activities in an effort to improve the quality of life for elder clients.
15. Work with resource agencies on coordinated service provisions to promote the expansion of existing programs for social support, and educational activities for all enrolled clients and their families. 
16. Manage the public relations for the Elder Services Program through the development of fliers, social media posts, and program brochures/newsletters. Provide up to date program and service information to all Homebound and Congregate elder clients. 
17. Develop and maintain automated data bases, summary reports, and graphics using various software packages in support of Program activities, operations and grant proposals.
18. Attend meetings, trainings, and sessions concerning client services and other federal, state, or county meetings relating to the Elderly Services Program as directed.  May be required to attend evening and/or weekend meetings.
19. Assist in scheduling appointments for clients, and assist program staff with follow-up cases to ensure that care plans are carried out and regularly evaluated. Interpret, support, and advocate for elders.
20. Participate in all emergency drills and environmental safety activities.
21. Attend and participate in grantee-sponsored trainings, program pre-service and in-service trainings, and other continuing education, career and professional development opportunities.
22. Participate in the program's self-evaluation process and grantee monitoring visits and comply with any applicable Program Improvement Plans that are developed.
23. Participate in general staff meetings and other meetings, conferences, and events planned by the grantees, and the program director.
24. Assist the Activities Planner as directed by the Program Director, in providing transportation and physical assistance services to elders for special functions and activities held off site.

Additional Responsibilities:

This position description in no way states or implies that these are the only duties performed by this employee.  He or she will be required to follow any other instructions or to perform any other duties requested or assigned by his or her supervisor.

Qualifications:

Education: High School diploma or general education degree (GED); and at least two years related work experience and training in case management, advocacy, and the psychological aspects of care. It is preferred that the incumbent have strong knowledge, certification, and training in areas of health care, social programs, and community resources. Experience working with the elderly population to provide translation and interpretation in the Keres language which allows for accurate data collection.  

Experience/Basic Knowledge: To perform the duties of this position successfully, an individual must be able to perform each essential duty effectively.  The requirements listed are a viable assessment of knowledge, skills, and abilities necessary for job performance.  Reasonable accommodations may be made to enable individuals with special needs, limitations and/or disabilities to perform the essential functions: 

• Knowledge of the rules and regulations related to the confidentiality of sensitive client and program information. Some knowledge of HIPPA regulations related to confidentiality and strict adherence to maintaining client information.
• Knowledge and strict adherence to Tribal, State, Federal and Local Policies and Procedures governing all facets of operating a compliant and effective Elderly Services Program.
• Must possess strong knowledge in case management activities including proficiency in maintaining accurate documentation and care records.
• Knowledge of case management principles including knowledge and experience working with elder clients in dealing with the psychological and emotional aspects of care.
• Knowledge of community and external resources and services available for the elderly population.
• Ability to communicate effectively with employees, elders, agency representatives, medical providers, and the general public using tact, courtesy, and common sense.
• Ability to monitor, assess, and track/record client progress against the care plan and make changes necessary to meet the client’s needs. Must have the ability to present progress and changes in writing and orally.
• Ability to establish and maintain effective working relationships with employees, elders, agency representatives, and the general public. Must be able to positively respond to stressful situations involving elder client services.
• Must possess strong interpersonal, problem solving, planning, time management and organizational skills.
• Must have the ability to exercise extreme patience and sensitivity while working with the elder population; and have the ability to resolve conflicts effectively. 
• Knowledge of records management and maintenance techniques; ability to read, translate, and interpret documents. Knowledge of office administration functions.
• Ability to understand and execute oral and written instruction. Knowledge of basic grammar, spelling, punctuation, and required formats. Must possess effective written and verbal communication skills.
• Demonstrated expertise in operating standard office equipment such as computers, typewriters, calculators, fax machines, and copy machines. Ability to utilize and apply software such as word processing, spreadsheets, graphics, desktop publishing, internet access and retrieval and database management.
• Ability to work independently in a fast paced environment, manage a high volume of work, set priorities and meet deadlines.
• Knowledge of basic rules, procedures, and practices for correspondence preparation and control, mail distribution, filing systems, records management, travel regulations, and other administrative functions.
• Ability to maintain a high level of accuracy in preparing and entering information with attention to detail.
• Knowledge of the Customs and Mores of the Pueblo of San Felipe and willingness to adhere to the practices with respect.

Required Licenses/Certifications: MUST HAVE VALID NM DRIVERS LICENSE AND BE INSURABLE. Must be willing to work towards obtaining case manager certification.

Physical Requirements: The individual is frequently required to sit for long periods of time. Occasionally required to walk, lift and /or move light to heavy boxes, and equipment when necessary. He/she will be required to escort elderly clients. Must have manual dexterity to enter/retrieve information and compile reports from a computer. Bends and stoops regularly.

Preferences: Keres language speaker preferred. Demonstrate ability to conduct public speaking and oral presentations on a one on one basis, and/or small group situations to elders, agency representatives, and other employees of the Tribal organization. Must have the ability to speak the Keres language fluently for the purposes of translation and interpretation.

Working Conditions:

The work is performed primarily indoors in an office setting requiring hand/eye coordination in the operation of office equipment. Due to the nature of the work, the incumbent is required to be able to walk, bend, stoop, lift, carry, etc. and will occasionally be exposed to outside weather conditions while performing duties and carrying out the scope of work. The work area is adequately lighted, heated and ventilated. Some local and distance travel is be required. Work involves some in/out of state travel to attend meetings, trainings, and conferences. Local travel is required to conduct home visits and deliver meals to home bound clients with potential exposure to pets/animals, disease, unsanitary conditions, and traffic hazards. The incumbent may be faced with constant interruptions and must meet the demands of caregivers, elderly clients, and the general public. Work environment is a drug free work place.

Additional Info:

Supervision and Guidelines: Work is performed under the general supervision of the Elderly Services Program Director. Incumbent will be responsible for providing daily supervision and oversight of the Outreach Worker/Data Entry Clerk position to ensure  accurate data collection and documentation further ensuring that outreach services and supports reach those with the greatest need. Work performance is evaluated through periodic checks of adequacy and timeliness of services provided and outcomes achieved. The Pueblo of San Felipe Organizational Policies and Procedures in conjunction with the programs standard operating procedures will serve as guidance documents in day to day operations and management of the incumbent.

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