Behavioral Health Case Manager  (Clinical Social Worker)

 Zócalo Health
Remote + Field-based — Full Time, San Bernardino
Compensation: 78,000 - 90,000 

About Us

Zócalo Health is a tech-enabled, community-oriented primary care organization serving people who have historically been underserved by the one-size-fits-all healthcare system. We partner with health plans, providers, and community organizations to deliver culturally competent primary care, behavioral health, and social care.

Our model is built for populations with high medical and social complexity, where fragmented care drives poor outcomes and unnecessary cost. We combine local, community-based teams with virtual care and modern technology to deliver coordinated, whole-person care where members live and receive support.

Founded in 2021, Zócalo Health is backed by leading healthcare and mission-aligned investors and is scaling rapidly across states and populations. We are building a durable care platform designed to perform in constrained healthcare environments and to lead the shift toward accountable, value-based care.

 

Role Description

Our care model is designed to meet members wherever they are—whether in their homes, online, or in their community. Behavioral Health Case Managers  are integral to our mission of providing culturally aligned and accessible care to the Latino community. They build trust through shared cultural and linguistic backgrounds, improving member engagement and access to care.

Zócalo Health is seeking a behavioral health case manager to serve as the primary point of contact for an assigned caseload of ECM members with behavioral health needs (including members with more complex mental health and/or substance use needs). This role provides relationship-based outreach, care navigation, care coordination, and brief skills-based behavioral health support to help members engage in appropriate services and move toward their goals.

Note: This role focuses on engagement, care coordination, and brief support strategies, including referrals and warm handoffs to psychotherapy, psychiatry, and Specialty Mental Health. 

This position reports to the Senior Director of Clinical Operations. You will work primarily in your community, with some work-from-home responsibilities.

 Responsibilities

• Play an active role in member registration and enrollment, including organizing community engagement and outbound outreach calls/texts.
• Conduct outreach (virtually and in-person) to members scheduled for appointments and complete initial intake and readiness-to-engage check-ins.
• Engage with a panel of assigned members to provide care navigation, appointment logistics, prescription drug support, lab support, referral coordination, care plan adherence support, and resource sharing.
• Coordinate access to behavioral health services, including referrals and warm handoffs to psychotherapy, psychiatry, and Specialty Mental Health. 
• Assess for social determinants of health (SDOH) needs and enroll members in SDOH programs, including care planning development, referral to community resources, coaching, and graduation/transition planning.
• Collaborate with a multidisciplinary care team to contribute to care plans, triage requests, and solve complex member needs.
• Document all member and care team interactions across multiple systems and tools.
• Participate in community events to support member activation and trust-building, including relationship-building with key contacts, facilitating group education sessions, and liaising with community organizations.
• Provide culturally and linguistically appropriate health education and information.
• Assist with federal and state support program enrollment, appointment scheduling, referrals, and promoting continuity of care.
• Support individualized goal setting using motivational interviewing.
• Conduct individual social needs assessments.
• Provide social support by listening to member concerns and connecting them to appropriate support resources.
• Attend and participate in community events as a Zócalo Health representative.
• Coordinate internal clinical services.