Care Coordinator

Postgraduate Center for Mental Health; New York (NY); On-site; USD 42,000 - 65,000; Full time

Job summary

Postgraduate Center for Mental Health is seeking a Care Coordinator to join the Care Coordination team under the Program Supervisor. You will address member needs, provide care plan updates, and conduct outreach between visits.

You will maintain contact with members, coordinate with medical and behavioral health providers, and support access to services and resources while documenting progress and outcomes.

Qualifications

• High School Diploma and CASAC plus four years of related human services experience.
• Associates degree in listed fields plus three years of related human services experience.
• Bachelor’s degree in listed fields plus two years of related human services experience.
• Master’s degree in listed fields plus one year of related human services experience.
• Experience providing direct services to individuals with chronic health and/or behavioral health disorders.

Responsibilities

• Coordinate care for a caseload of 40-50 members.
• Maintain monthly contact with all members of assigned caseload, with added contact for new/high-risk members.
• Engage members after handoff from Outreach Team via face-to-face, mail, electronic, and phone.
• Communicate with primary and specialty care physicians and providers on behalf of members.
• Maintain records, statistics, and reports per policy and procedure.
• Conduct initial and periodic needs assessments, addressing barriers and assets.
• Assist with developing and executing care plans and tailoring communications to health literacy levels.
• Record client progress against care plan goals.
• Assist members with accessing healthcare and social systems, including transportation and appointments.
• Identify community resources; manage referrals, access, engagement, and follow-up.
• Coordinate access to individual/family supports and resources.
• Help members manage daily routines related to healthcare and resources.
• Conduct outreach/engagement activities to maintain continuity of care; re-engage if needed.
• Provide crisis intervention and follow-up.
• Monitor entitlements, insurance, and benefits to stay active.
• Advocate for members to resolve crises.
• Collaborate with professionals to assess medical/behavioral health needs.
• Oversee emergency on-call for 2-3 weeks per year.
• Manage wrap-around funds, metro cards, and checks per member goals.

Skills

Care coordination

Outreach

Crisis intervention

Communication

Advocacy

Education

High School Diploma + CASAC

Associate Degree in Human Services

Bachelor’s Degree (Social Work / Psychology / Education)

Master’s Degree (Social Work / Psychology / Education)

Job description

JOB SCOPE:

As a member of the Care Coordination team and under the supervision of the Program Supervisor, the Care Coordinator is responsible for addressing all member needs, providing care plan updates and conducting outreach to members in between visits. Care Coordinators

JOB SCOPE:

As a member of the Care Coordination team and under the supervision of the Program Supervisor, the Care Coordinator is responsible for addressing all member needs, providing care plan updates and conducting outreach to members in between visits. Care Coordinators

• coordinates care for a caseload of 40-50 members;
• maintains monthly contact will all members of assigned caseload, with increased contact for newly enrolled and high risk members;
• upon handoff from the Outreach Team, conduct member engagement activities, including face-to-face, mail, electronic, and telephone contact;
• establish and maintain effective communication with primary and specialty care physicians, substance abuse and mental healthcare providers, family, collateral resources and other agency staff on behalf of members;
• maintain documents, records, statistics, and other related reports in an organized, timely and accurate manner as per policy and procedure;
• conduct initial and periodic needs assessments, including assessing barriers and assets (i.e. transportation, community barriers, social supports); member and family/caregiver preferences and language, literacy, and cultural preferences;
• assist with the development and execution of member’s care plans, including assisting members in understanding care plans and instructions and tailoring communications to appropriate health literacy levels;
• record client progress according to measurable goals described in his/her care plan;
• assist members with accessing healthcare and social systems, including arranging for transportation and scheduling and accompanying members to appointments;
• assist members with identifying available community-based resources and actively manage appropriate referrals, access, engagement, follow-up, and coordination of services;
• Assist with coordinating members’ access to individual and family supports and resources.;
• assist members with managing daily routines related to healthcare and incorporating members’ strengths and identifying barriers;
• assist with conducting outreach and engagement activities that support continuity of care, including re-engaging members in care if they miss appointments and/or do not follow-up on treatment;
• provide crisis intervention and follow-up;
• monitor member entitlements, insurance, and other benefits to ensure they remain active and in place;
• advocate for members to resolve crises;
• collaborate with other professionals to evaluate members’ medical or behavioral health condition and to assess member needs;
• responsible for emergency on call for 2 to 3 weeks out of the year;
• Manage wrap around funds, metro cards and checks for member purchases, including obtaining the necessary approvals for all purchases in keeping with the member’s goals.

Qualifications

EDUCATION AND EXPERIENCE:

High School Diploma and CASAC plus four (4) years of related human services experience in providing direct services to individuals with chronic health and/or behavioral health disorders.

or

• Associate Degree in one of the following fields: Human Services, Psychology, Rehabilitation, Nursing, Occupational Therapy, Counseling, Community Mental Health, Sociology, Speech and Health, Physical or Recreational therapy. Plus three (3) years of related human services experience in providing direct services to individuals with chronic health and/or behavioral health disorders.

or

• Bachelor’s Degree in one of the following fields: Social Work, Psychology, Education, Rehabilitation, Nursing, Occupational Therapy, Counseling, Community Mental Health, Sociology, Speech and Hearing, Physical or Recreational therapy. Plus two (2) years of related human services experience in providing direct services to individuals with chronic health and/or behavioral health disorders.

or

• Master’s Degree in one of the following fields: Social Work, Psychology, Education, Rehabilitation, Nursing, Occupational Therapy, Counseling, Community Mental Health, Sociology, Speech and Health, Physical or Recreational therapy. Plus one (1) year of related human services experience in providing direct services to individuals with chronic health and/or