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Care Coordinator

2 months ago

Staten Island, New York, United States Institute for Community Living , Inc. Full time
Care Coordinator Job Summary

The Institute for Community Living, Inc. is seeking a skilled Care Coordinator to join our interdisciplinary team. As a Care Coordinator, you will provide care coordination to a caseload of severely mentally ill adults with multiple medical comorbidities and/or co-occurring substance abuse disorders and/or medically ill individuals.

Key Responsibilities:
  • Conduct initial and ongoing assessments of assigned clients to document strengths, needs, goals, and resources.
  • Participate in the development/documentation/review and update of client-centered comprehensive integrated, interdisciplinary care plans in consultation with other team members.
  • Maintain effective communications with clients, primary care physicians, substance abuse, and mental healthcare providers, family, collateral resources, and other Agency staff on behalf of clients.
  • Maintain documents, records, statistics, and other related reports in an organized, timely, and accurate manner as per policy and procedure.
  • Coordinate care planning with other providers of services/resources to ensure goal-directed, collaborative care, including care transitions.
  • Work as part of a Care Coordination team; attend and participate in team meetings to provide input/feedback around psychosocial and medical conditions/comorbidities to review client status, update plans and goals, review outcomes to further program goals.
  • Act as a resource/consultant to all team members on psychosocial, medical, and/or substance abuse issues and resources.
  • Provide telephonic as well as face-to-face outreach, engagement, and service planning in the field.
  • Act as a linkage to community services including medical, behavioral, residential, entitlement, and any other needed services per interdisciplinary care plan.
  • Monitor overall service delivery to clients to ensure coordination and continuity; advocate with service providers/resources as needed.
  • Provide crisis intervention and follow-up.
Requirements:
  • A bachelor's degree in one of the fields listed below or a NYS teacher's certificate for which a bachelor's degree is required or NYS licensure and registration as a Registered Nurse and a bachelor's degree or a Bachelor's level education or higher in any field with five years of experience working directly with persons with behavioral health diagnoses or a Credentialed Alcoholism and Substance Abuse Counselor (CASAC).
  • Two years of experience in providing direct services to people with Serious Mental Illness, developmental disabilities, or substance use disorders or linking individuals with Serious Mental Illness, developmental disabilities, or substance use disorders to a broad range of services essential to successful living in a community setting.
Preferred Qualifications:
  • A master's degree in one of the qualifying education fields may be substituted for one year of experience.
  • Working knowledge of computer software and electronic health record systems.
  • Demonstrated competency in written, verbal, and computational skills to present and document records in accordance with program standards.
  • Experienced in and demonstrated comprehensive understanding and working knowledge of the interdisciplinary planning process and the developmental treatment model.
  • Knowledge of Medicaid, Social Security, and other entitlements preferred.
  • Excellent interpersonal skills required.
  • The ability and willingness to regularly travel, in some instances with clients in Agency vehicles, to many locations using various modes of reliable and safe transportation.
Training Requirements:
  • Specific training for the designated assessment tool(s), the array of services and supports available, and the client-centered service planning.
  • Training in assessment of individuals whose condition may trigger a need for HCBS and supports, and an ongoing knowledge of current best practices to improve health and quality of life.
  • Mandated training on the New York State Community Mental Health Assessment instrument and additional required training.