ICM Case Manager

SPECIAL SERVICE FOR GROUPS INC

Job Description Title: ICM Case Manager Division: HOPICS Permanent Supportive Housing

FLSA: Non-Exempt Full Time Supervisor: Program Manager

Pay Scale: $22.00 - $26.00 per hour

Summary Under the direction of the Program Manager, the Intensive Case Management Services Permanent Supportive

Housing Case Manager provides participant-centered, housing-focused case management and care coordination to people experiencing homelessness who have complex health, behavioral health, substance use, and social-service needs. The ICMS Case Manager supports participants from referral and engagement through permanent housing placement and long-term housing retention. Services are delivered according to Housing First, harm reduction, trauma-informed care, and cultural humility principles and must comply with Agency, Los Angeles County Homeless Services and Housing, program, privacy, documentation, and funding requirements.

Essential Functions

• Outreach Intake and Engagement

Manage an assigned ICMS caseload without exceeding 100 percent of a full caseload and adjust service intensity according to each participant's needs, acuity, housing status, and Care Plan.

• Accept and process referrals and make reasonable, persistent efforts to contact participants within seven business days of referral or slot assignment.
• Complete face-to-face intake activities within seven days of slot assignment, including required program forms,

consents, authorizations, opt-ins, participant rights, grievance information, and privacy notices.

• Build trusting relationships through a participant-centered, strengths-based, low-barrier, and culturally responsive approach.
• Coordinate with referral sources, street outreach teams, interim housing providers, housing navigators, County

staff, healthcare providers, and other members of the participant's care team.

Assessment and Care Planning

• Complete a comprehensive face-to-face Initial Assessment using County-approved tools within 30 days of

enrollment and enter the results in CHAMP.

• Develop an individualized Care Plan within 30 days of enrollment that includes participant-selected SMART goals, action steps, target dates, and expected outcomes.
• Complete reassessments and update the Care Plan at least every 90 days, or sooner when participant needs,

risks, or circumstances change.

• Assess needs across housing, physical health, mental health, substance use, activities of daily living, income,

benefits, legal, education, employment, family, social supports, safety, and community functioning.

Housing Navigation and Stabilization

• Support participants with housing eligibility and subsidy documentation, applications, unit searches, viewings,

property-management meetings, lease review, move-in coordination, furnishings, and basic move-in needs.

• Complete and coordinate subsidy applications within applicable program timeframes, including 14 days after slot entry for project-based voucher matches and 21 days for tenant-based voucher matches.
• Educate participants about tenant rights and responsibilities, lease compliance, rent payment, budgeting, unit

maintenance, neighbor relations, and communication with property management.

• Provide eviction-prevention counseling, advocacy, mediation, reasonable-accommodation support, and referrals to no-cost legal services when housing stability is at risk.
• Monitor rental-assistance or subsidy issues through required portals and promptly coordinate with program

leadership, payment providers, property management, and County staff when barriers arise.

Tenancy Support and Care Coordination

• Maintain regular participant contact and provide at least two documented ICMS services per participant each

month.

• Complete at least one meaningful in-person encounter per month for participants in the low service-intensity tier and at least two per month for participants in the high service-intensity tier, with additional contact based on need.
• Conduct home visits, health and safety visits, field visits, hospital transition-of-care visits, and community-based contacts as appropriate to participant needs and the Care Plan.
• Connect participants to primary and specialty healthcare, mental health care, substance-use services, benefits, health insurance, employment, education, transportation, legal assistance, food, identification documents, and other community resources
• Coordinate case conferences and multidisciplinary services with County departments, managed care plans,

housing authorities, property management, family or supports authorized by the participant, and other service

providers.

• Provide crisis intervention and safety planning, follow incident-reporting requirements, and support access to 24- hour crisis resources, overdose-response education, and naloxone.
• Support successful transitions and exits by coordinating ongoing housing, healthcare, behavioral health, benefits, and community services and obtaining required County approval.

Documentation Reporting and Compliance

• Maintain accurate, complete, timely, and confidential participant records in CHAMP, HMIS, and other required

systems.

• Enter services and case notes under the appropriate SMART goal in the participant's Care Plan within three

business days of service delivery. Notes must identify the service provided, participant engagement, progress,

outcomes, and follow-up actions.

• Use the correct CHAMP Service Option and Place of Service and ensure documentation reflects services actually delivered. Never create, backdate, or alter documentation to misrepresent services or meet billing requirements.
• Complete monthly Permanent Housing Updates in CHAMP and keep housing status, address, Service Planning Area, move-in and subsidy milestones, and assigned case manager information current.
• Maintain required enrollment, consent, assessment, Care Plan, reassessment, incident, case closure, benefits,

health-home, insurance, and program participation documentation.

• Review data-quality reports, correct identified errors within required timeframes, and submit productivity, outcome, and other reports as assigned.
• Protect participant information and comply with HIPAA, applicable confidentiality requirements, universal

information-sharing consent limitations, Agency policy, and County requirements.

Collaboration and Professional Responsibilities

• Attend and actively participate in team meetings, case conferences, performance-improvement activities, required trainings, and regular clinical supervision with an appropriately licensed clinical supervisor.

• Maintain an active CHAMP account and complete required ICMS, privacy, safety, documentation, and case-

management training within established deadlines.

• Represent the Agency professionally in participant homes, housing sites, community settings, partner meetings, and interagency collaborations.
• Maintain regular attendance and follow Agency safety, ethics, mission, values, policies, procedures, and

supervisory direction.

• Perform other duties as needed and assigned.

Secondary Functions

• Provide administrative support or backup coverage as assigned, including phone coverage, file review, document preparation, and participant coordination.
• Perform related duties assigned by the Program Manager, Senior Program Manager, Division Director, Deputy

Director, or other authorized Agency leadership.

Minimum Qualifications Knowledge Skills And Abilities Required

• Associate degree in social services, human services, behavioral health, or a related field, or two years of relevant case-management or social-services experience.
• At least one year of experience serving people experiencing homelessness, people with complex health or

behavioral health needs, or participants in supportive-housing programs is preferred.

• Knowledge of Housing First, harm reduction, trauma-informed care, motivational interviewing, crisis intervention, and participant-centered service delivery.
• Ability to complete assessments, develop measurable Care Plans, coordinate multidisciplinary services, and

maintain detailed records within required timelines.

• Proficiency with Microsoft Word and Excel and electronic participant-record systems. Experience with CHAMP and HMIS is preferred.

• Strong written and verbal communication, sound judgment, organization, time management, and attention to detail.

• Ability to work independently and collaboratively with people from diverse cultural, ethnic, gender, sexual-

orientation, ability, and socioeconomic backgrounds.

• Valid California Driver License, reliable transportation, and proof of current automobile insurance are required for field responsibilities.
• Must pass employment-eligibility verification and required background clearance.
• Must successfully complete and maintain required tuberculosis testing in accordance with Agency requirements.
• CPR and First Aid certification are required and may be obtained upon hire.

Supervisory Responsibilities None.

Environmental Conditions Working Conditions

• Work is performed in office and field settings, including participant homes, permanent and interim housing sites, hospitals, clinics, community locations, and other service settings throughout Los Angeles County.
• The position requires regular travel between service locations and may involve exposure to high-stress situations, unsanitary conditions, communicable illness, or unpredictable environments.
• The position may require occasional evening or nontraditional hours based on approved program and participant needs.

Physical Requirements

• Frequently required to sit, stand, walk, drive, listen, speak, use a computer, and carry items weighing up to 25

pounds.

• Must be able to travel between sites, conduct home and community visits, and safely perform field-based

responsibilities.

Mental Requirements

• Must be able to manage a complex caseload, prioritize competing deadlines, process detailed information, respond to crises, and maintain focus and accuracy during interruptions.
• Must exercise professional boundaries, sound judgment, confidentiality, and adaptability while working with

participants who may have complex needs.

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