Care Management Specialist - Bilingual

Our Mission: 

The mission of Bread for the City is to help Washington, DC residents living with low income develop the power to determine the future of their own communities. We provide food, clothing, medical care, and legal and social services to reduce the burden of poverty. We seek justice through community organizing and public advocacy. We work to uproot racism, a major cause of poverty. We are committed to treating our clients with the dignity and respect that all people deserve.

Summary: 

Bread for the City began as a front line agency in 1974 and our mission is to provide comprehensive services, including food, clothing, medical care, and legal and social services to our clients in an atmosphere of dignity and respect. All people share a common humanity and are responsible to themselves and to society as a whole. We promote the mutual collaboration of clients, volunteers, donors, staff and other community partners to alleviate suffering caused by poverty and to rectify the conditions that perpetuate it.

Position Profile:

Bread for the City’s primary care clinic is a medical home that seeks to provide wrap-around medical, behavioral and social services to all medical patients. The Care Management Specialist builds capacity for the medical clinic to better serve its clients by assessing social needs and providing care management services to medical patients. To accomplish this goal, the specialist will work with the Social Services team to maintain an up to date resource manual, research social service and health care resources, network with other social services providers, and implement systems to better meet the needs of medical patients. 

In addition, the Health Resource Room, where the specialist sits, is a place where medical patients can go after they see their doctor to sign up for the patient portal, access health information and wellness programs, navigate the healthcare system, and obtain referrals to social service resources internally and externally.  We are looking for an energetic and flexible self-starter, who is passionate about empowering medical patients and dedicated to working in a collaborative and multi-cultural environment.

Essential Duties and Responsibilities:

Provide immediate social needs screening, bio-psycho-social assessments and care planning with medical patients

• When patients identify social need, complete appropriate screening, assessing and care planning with patients;
• Provide immediate social services resources/referrals, or follow-up calls, when appropriate;
• Provide brief, supervised case management support for patients who needs help with concrete social service needs, including My Health GPS patients;
• Acquire motivational interviewing skills to support clients who are making dietary or other lifestyle changes and have been referred from providers or behavioral health specialists, particularly for My Health GPS population;
• Connect patients to free wellness resources throughout the city, including DC parks and rec classes, DC Office on Aging wellness centers.

Social Service Resources

• Connect patients to appropriate Bread for the City programs and staff;
• Stay current with organization resources for clients and publicize in medical clinic (ie. monthly volunteer orientation, farmer’s market, etc.);
• Manage medical resource wall;
• Manage changes in health care insurance coverage to ensure patients and providers are aware of the process to obtain medical equipment and specialty medical referrals.

Healthcare Literacy

• Connect patients to the Patient Portal. Provide basic computer assistance 1 on 1 to support client’s access to portal and other health information;
• Help clients learn about their condition and assist in finding health information through the use of video, literature and medically appropriate sites to answer health questions;
• Help clients select a pharmacy, understand the referral process, book non emergency medical transport, troubleshoot PCA and medical equipment orders, etc.

Care Management Leadership

• Take ownership of projects/programs, as decided with supervisor;
• Assist in supervision of social work students.

Training and Supervision

The Care Management Specialist must attend the Bread for the City new staff orientation.  They will also have options for additional trainings, as well as continuing education as needed for licensure. They will receive ongoing, weekly supervision from the Associate Director of Care Management, including on learning about internal and external social service resources and best practices in working one-on-one with patients.

Required skills and experience:

• Master’s degree in social work.  If an applicant has BSW or MSW, must also be licensed in DC at the LGSW level or have license pending under 90 day practice rule.  If practicing under the 90 day rule, applicants must obtain their license before the supervision letter expires in order to maintain employment.   
• Fluency in English and Spanish;
• Desire and ability to provide services within an atmosphere of dignity and respect;
• Ability to build rapport with diverse clients, coworkers and colleagues through effective communication, listening skills, and empathy;
• Commitment to social justice issues;
• Strong organizational and time management skills, attention to detail, and the ability to juggle multiple tasks and set priorities to meet deadlines;
• Professional demeanor, excellent customer service and telephone skills, and interpersonal skills;
• Experience working within a model of Trauma Informed Care or a desire to do so;
• Commitment to the following principles: staff and patient safety, trustworthiness and transparency, the value of lived experience, collaboration and mutuality, patient empowerment, belief in the importance of our patients, and resilience;
• Strong commitment to promote cultural, racial, language, and gender access and equity;
• Ability and commitment to document as needed and required by agency in appropriate databases;
• Strong computer skills, including the capacity to use Microsoft Office and learn other programs to manage a high volume of detailed information and responsibilities;
• Familiarity with Google Organization & productivity tools (Gmail, Google Docs, Calendar) and/or ability to learn new technology systems;
• The ability to work with volunteers in a professional and collaborative manner;
• Willingness to learn and carry out Bread for the City's commitments to social justice and racial equity;

The following are a plus but not required:

• Familiarity with federal and state public benefits programs;
• Familiarity with federal and DC subsidized housing programs.

Compensation:

Starts at $55,000; depending on experience could make up to $65,000

Bread for the City is an equal opportunity employer and does not discriminate on the basis of race, color, religion, sex, pregnancy, national origin, ancestry, age, marital status, sexual orientation, family responsibility, physical or mental disability, medical condition, status as a veteran, or any other category protected by applicable federal, state, or local law, except where a bona fide occupational qualification applies.