Psychiatric Social Worker I-ODR ECM
4 weeks ago
At Heluna Health, we are seeking a highly skilled Patient Care Coordinator to join our team. The ideal candidate will have a Master's degree in Social Work and experience providing individual, group, or family psychotherapy, assessment and treatment planning, or clinical case management with populations similar to those with serious mental illness, substance use disorders, and experiences of homelessness or incarceration.
Key Responsibilities
Outreach and Engagement
• Conduct outreach and engagement activities to locate, contact, and engage clients in collaboration with the assigned ICMS, document efforts, and provide education on the services provided.
Comprehensive Assessment and Care Management Plan
• Conduct assessments of clients' psychosocial and service needs through interview and evaluation, review of medical and mental health records, and consultation with ICMS, primary care, housing community services, and mental health care team members.
Enhanced Coordination of Care
• Partner with other agencies providing services to clients, including collaborating on service plans and progress with assigned clients, identifying, and troubleshooting service issues, and providing consultation.
• Assess mental health and substance use needs of assigned clients and provide linkage to appropriate community-based services.
• Work with the ODR Clinical team on interviewing persons seeking psychiatric assistance on an emergency basis and utilize crisis intervention techniques to prevent hospitalization and to aid the person in dealing with emotional and/or health crises.
• Maintain documentation of social work/case management activities including assessments, care plans, and progress notes.
• Review records and information from multiple data systems when making treatment decisions.
Health Promotion
• Use evidence-based practices, such as motivational interviewing, to engage and help clients meet their needs and preferences. Management of members' chronic conditions can include, but not be limited to, linking members to resources for smoking cessation, referrals to gyms, coaching to encourage lifestyle choices to manage their health, assistance in identifying and building on potential family and/or support networks.
Transitional Care Services
• Assist clients and facilitate safe and appropriate transitions from one setting or level of care to another when necessary.
Member and Family Support
• Collaborate with the client's authorized support person in meeting the client's needs. Services include, but are not limited to, ensuring required authorizations are in place to warrant effective communication, provide appropriate education about the client's condition in accordance with privacy and confidentiality laws, identify supports needed for the client and the authorized support person to ensure progression of client's goals.
Coordination of and Referral to Community and Social Support Services
• Provide referrals to community social support services, including determining appropriate services to meet the clients' needs and coordinating and referring the clients to available community resources and following up with the clients to ensure services were rendered.
• Participate in team conferences, staff meetings, and clinical consultations to be up to date on new developments.
• Network, outreach, consult, and collaborate with community organizations and countywide agencies, develop relationships, and collaborate with community providers to build resources to utilize for clients.
Requirements
A Master's degree from an accredited school of social work and experience providing individual, group, or family psychotherapy, assessment and treatment planning, or clinical case management with populations similar to those with serious mental illness, substance use disorders, and experiences of homelessness or incarceration. A valid and active Associate Clinical Social Worker registration issued by the California Department of Consumer Affairs, Board of Behavioral Sciences, and a valid California Class C Driver License or the ability to utilize an alternative method of transportation when needed to carry out job-related essential functions.
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