Care Coordinator I, Integration, Enhanced Care Management

Native American Health Center; Oakland (CA); On-site; USD 52,000 - 76,000; Full time

Job summary

The Native American Health Center in Oakland, CA is seeking a Care Coordinator I, Integration – Enhanced Care Management to join its Behavioral Health team. You will work with providers across the NAHC system to connect clients with an integrated, holistic care plan and perform care coordination, case management, and warm hand-offs.

You will conduct assessments, develop individual care plans, and support members with health education, resources, and navigation to services.

Responsibilities

• Manage a diverse caseload of adults, youth, and families to meet Enhanced Care Management program criteria.
• Screen and assess members for mental health, substance abuse, and social needs.
• Develop, implement, and monitor individual care plans in a culturally sensitive approach.

Job description

POSITION: Care Coordinator I, Integration – Enhanced Care Management

DEPARTMENT: Behavioral Health

REPORTS TO: Care Coordinator IV, Integration

LOCATION: Native American Health Center, Inc.

2950 International Blvd., Oakland, CA 94601

WORK HOURS: Full Time, 40 hours per week, 100% FTE

STATUS: Non-Exempt, Union

Position Summary

The Care Coordinator functions as a member of an integrated system of care team who will work with providers across NAHC and other systems of care to provide NAHC clients with access to an integrated, holistic system of care. The Care Coordinator will provide care coordination, case management, member navigation, system navigation (internal and external), peer advocacy, health education, mapping individual, family and community supports and assets, panel management support, home visits (when appropriate), and warm handoff services. The Care Coordinator may work with other mental health providers when such treatment is indicated. The Care Coordinator may assist with writing reports when appropriate. The Native American Health Center is an accredited institution and adheres to the standards of excellence set forth by the Accreditation Association of Ambulatory Health Care (AAAHC) and the Commission of Dental Accreditation (CODA).

Duties and Responsibilities

• Manage a diverse caseload of adults, youth, and families that meet criteria for the Enhanced Care Management program set by the state with a shared understanding of the respective roles and responsibilities of team members to ensure that collaboration is efficient.


• Screen and assess members for common mental health, substance abuse, and social resource needs.


• Develop, implement, and monitor individual plans of care using a culturally sensitive and strengths-based approach, to assist members and families to cope and/or restore social, emotional, financial and environmental factors that affect and/or are affected by illness.


• Identifies members not improving on health/wellness goals and/or with urgent healthcare needs to assist with prioritization for treatment adjustment or case review with the treatment team.


• Accurately and expediently complete electronic and case management systems documentation and other data collection components related to mental health services.


• Meet mental health visit goals as required for various contracts.


• Provide early intervention, direct services, referrals, and liaison services between agencies as needed to support members with medical, behavioral health, and social services needs to promote overall health.


• Provide individual, group, and family crisis intervention and aftercare/discharge support. Link to emergency services as needed, as well as ongoing case management, which may include interacting with police, psychiatric services, hospitals, and other community agencies and staff.


• Provide member education about common mental health, substance abuse disorders, and chronic health conditions and available treatment options.


• Work collaboratively to resolve differing perspectives, priorities and schedules among providers.


• Connect healthcare consumers and family members to other members of the healthcare team through face-to-face encounters known as "warm hand-offs."


• Represent the program, department and agency in a positive and professional manner at all times.


• Provide appointment reminders to members and facilitate access to services.


• Member Care: Demonstrate understanding and apply working knowledge of safety policies and ensuring safe member practices.


• Employee Safety: Safely performs all duties; follow required protective protocols to ensure personal safety as well the safety of others.


• Must maintain compliance with ergonomic safety standards; be mindful of posture and regularly practice ergonomic stretches.


• HIPAA: Keep all protected health information (PHI) confidential and abide by HIPAA policies for the release and disclosure of any PHI. Will report unauthorized use of disclosure of PHI immediately, to supervisor or HIPAA security officer.


• Work well under pressure, meet multiple and often competing deadlines.


• At all times demonstrate cooperative behavior with supervisors, subordinates, colleagues, clients and the community.


• Other duties as assigned by Supervisor.