One Care Plan Advocate

Old Colony YMCA; Brockton (MA); On-site; USD 52,000 - 76,000; Full time

Benefits offered by this job

Great work/life balance

35-hour work week

Frequent travel between sites

Professional development

Job summary

OCES seeks an LTSS Coordinator to join our team, supporting older adults and individuals with disabilities on the South Shore. You will help identify appropriate LTSS options and contribute to ICP development, joining a multidisciplinary ICT team to coordinate community services.

The role requires delivering assessments, advocating for enrollee needs, and facilitating facility-based LTSS reviews while maintaining strong communication with families and providers. Some travel is expected.

Qualifications

• Bachelor's degree in social work or related field.
• Current Social Work License (LSW or higher), or LMHC preferred.
• Minimum two years of experience in behavioral health or case management.

Responsibilities

• Identify if enrollee needs beyond LTSC expertise during initial assessment.
• Develop LTSS component of ICP and participate as ICT member.
• Coordinate community LTSS and resources including Personal Care Attendant services.
• Identify community alternatives to long-term institutional care.
• Monitor ICP for service effectiveness upon ICT request.
• Assess health and functional status of OCP enrollers.
• Advocate for enrollee needs and educate on LTSS to ICT and enrollee.
• Assess facility LTSS suitability including accessibility and equipment needs.

Skills

Social work knowledge

Interdisciplinary team

Communication skills

Interviews & assessment

Regulatory understanding

Relationship management

Writing & documentation

Community resources

Education

Bachelor's degree in social work

LSW or LMHC preferred

Job description

OCES is growing! We are expanding to 11 more towns covering the south shore area, including Quincy, Braintree, Weymouth, etc. during this exciting time!

OCES supports older adults and individuals with disabilities by providing vital information and coordination of services. By promoting healthy, safe living for our consumers, we hope to allow them to stay active and engaged in their lives and in their own communities for as long as possible.

Our mission: Through the talents of an experienced and diverse workforce, OCES supports the independence and dignity of older adults and individuals with disabilities by providing essential information and services that promote healthy, safe living which positively impacts our community.

What You’ll Do

• Assisting in identifying a more appropriate LTSS Coordinator (LTSC) if, after initial assessment, it is determined that enrollee has special needs outside the Advocate's/LTSC's expertise
• Developing or assisting in the development of the LTSS component of an Individual Care Plan (ICP), participating as a full member of the ICT
• Facilitating the provision of appropriate community LTSS and resources including Personal Care Attendant services
• Identifying community-based alternatives to long-term institutional care
• Monitoring the provision and effectiveness of community services according to the ICP, upon request from the ICT
• Conduct initial and ongoing assessments of the health and functional status of OCP enrollers
• Representing the needs of the OCP enrollee by identifying communication and support needs, advocating for the enrollee, and providing education on LTSS to the ICT and enrollee
• Upon request from the ICT, participating in assessing appropriateness of facility based LTSS, including but not limited to assessment of any accommodation, accessibility and equipment needs
• Other duties as assigned.

What You’ll Bring

• Considerable knowledge of the principles and practices of social work as well as the social, emotional, and physical processes of aging
• Ability to hold the confidence of elders and their families; ability to obtain information of a personal nature through interviews, draw appropriate conclusions and make suitable recommendations
• Ability to establish and maintain harmonious working relationships with consumers and staff
• Ability to interpret, understand and adhere to complex regulations, standards, and procedures
• Knowledge and skill necessary to work successfully within an interdisciplinary team; ability to express clearly, both orally and in writing
• Bachelor's degree in social work or related field Current Social Work License (LSW or higher), or LMHC preferred
• Minimum two years of experience in behavioral health or case management

What You’ll Get

• Ability to work with an enthusiastic team of like-minded individuals
• Opportunity to develop professionally in your chosen career
• Great work/life balance: 35-hour work week with some flexibility; standard M-F workweek
• Frequent travel between work sites
• Routine communication with others by phone, in person and writing
• Must be able to lift to 25 pounds at times
• Reliable means of transportation; computer at home with internet access and mobile phone

OCES is an open, welcoming organization that respects our diversity.