Care Coordinator

1 month ago

Brooklyn, New York, United States Institute for Comm Living Full time
Job Summary

The Care Coordinator plays a vital role in our interdisciplinary team, providing care coordination to individuals with severe mental illness, multiple medical comorbidities, and/or co-occurring substance abuse disorders. This dedicated professional will advocate for and support clients, engaging with community agencies, healthcare providers, and other stakeholders to ensure access to necessary services, promoting wellness self-management, and reducing emergency room visits and hospitalizations.

Key Responsibilities
  • Conduct thorough assessments of assigned clients to document strengths, needs, goals, and resources.
  • Participate in the development, documentation, and review of client-centered comprehensive integrated care plans, collaborating with team members to ensure focus on desired outcomes.
  • Maintain effective communication with clients, primary care physicians, substance abuse and mental healthcare providers, family, collateral resources, and other Agency staff on behalf of clients.
  • Ensure accurate and timely documentation, records, statistics, and reports, adhering to policy and procedure.
  • Coordinate care planning with other providers of services and resources to ensure goal-directed, collaborative care, including care transitions.
  • Collaborate with the Care Coordination team, attending and participating in team meetings to provide input and feedback on psychosocial and medical conditions, reviewing client status, updating plans and goals, and reviewing outcomes to further program goals.
  • Act as a resource and consultant to team members on psychosocial, medical, and/or substance abuse issues and resources.
  • Provide telephonic and face-to-face outreach, engagement, and service planning in the field.
  • Link clients to community services, including medical, behavioral, residential, entitlement, and other necessary services, as per the interdisciplinary care plan.
  • Monitor overall service delivery to clients, ensuring coordination and continuity, and advocating with service providers and resources as needed.
  • Provide crisis intervention and follow-up services.
  • Perform other tasks and duties reasonably related to the job responsibilities.
Requirements
  • 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.
  • Experience 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.
  • Ability and willingness to regularly travel, in some instances with clients in Agency vehicles, to various locations using reliable and safe transportation.
Training and Qualifications
  • Specific training for designated assessment tools, services, and supports available, and client-centered service planning.
  • Mandated training on the New York State Community Mental Health Assessment instrument and additional required training.
Qualifications and Experience
  1. A bachelor's degree in a qualifying field, such as social work, psychology, nursing, or a related human services field.
  2. Two years of experience in providing direct services to individuals with serious mental illness, developmental disabilities, or substance use disorders, or linking individuals to a broad range of services essential to successful living in a community setting.

A master's degree in a qualifying field may be substituted for one year of experience.

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