• Conduct comprehensive psychosocial assessments to identify patient and family needs • Develop and implement treatment plans in collaboration with interdisciplinary teams • Conduct discharge planning and coordinate community resources • Collaborate with physicians, nurses, and other healthcare professionals to ensure holistic patient care • Coordinate referrals to community resources, support services, and specialty care • Facilitate communication between patients, families, and medical teams • Participate in interdisciplinary team meetings and case conferences • Provide emotional support and counseling to patients facing medical diagnoses • Educate patients and families about medical conditions, treatment options, and coping strategies • Assist with advance directive planning and end-of-life care discussions • Maintain accurate and timely clinical documentation in proprietary technology and/or electronic health records • Ensure compliance with HIPAA, state regulations, and hospital policies • Complete required assessments within established timeframes

• Coordinate Resources and Build Provider Networks • Develop and maintain a comprehensive directory of supportive service providers to address diverse Job Seeker barriers. • Track each client's progress and requests for assistance by keeping accurate, timely records and reporting outcomes as required. • Monitor and document the progress of each Job Seeker as you guide them through personal barriers on their path to employment. • Coordinate approvals and payments for necessary costs, actively aiding Job Seekers in utilizing no- or low-cost solutions whenever possible. • Maintain reliable database utilization and record-keeping to support program compliance and reporting requirements. • Navigate Barriers and Advocate for Job Seekers • Communicate regularly with Job Seekers regarding their current barriers and the potential supportive services available to them. • Collaborate closely with Regional Workforce Development Managers to understand each Job Seeker's unique history, barriers, and service needs. • Make appropriate referrals and facilitate active Job Seeker engagement with service providers to ensure clients leverage the maximum benefits available

• Responsible for guiding individuals with developmental disabilities, and their families, through a new California Policy called Self Determination • Lead people through a person-centered planning process • Develop person-centered plans • Guide them through a budgeting process • Advocate for them with Regional Centers • Assist customers with finding tailored support services, community supports, activities, and direct support staff

• Provides care management support to a panel of patients who require specialty services integrated and in support of their overall plan of care. • Interacts with and supports the specialty care providers, primary care providers and the interdisciplinary care team across the continuum of care. • Assesses, plans, implements, documents, coordinates, monitors, evaluates, and updates the plan of care by collaborating with all members of the health care team to provide evidenced-based care. • Works to establish collaborative processes that promote quality and cost-effective care that optimizes the physical and psychosocial health of patients. • Responsible for supporting decisions that impact health care outcomes, resource allocation and customer experience. • Engages in quality improvement initiatives and program development.