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JOB SUMMARY:
The Adult Home Care Coordinator functions as a member of an interdisciplinary team to provide care coordination to a caseload of severely mentally ill adults with multiple medical comorbidities and/or co-occurring substance abuse disorders and/or medically ill individuals.
Advocates for and supports the client, engages with community agencies/health care providers and others on his behalf to ensure access to services needed to increase wellness self-management and reduce emergency room visits and/ or hospitalizations.
Provides clinical support to the Team by providing consultation, education, information around psychosocial and/or substance abuse conditions, interventions, resources to maintain focus on outcomes and best practices.
RESPONSIBILITIES:
Conducts initial and ongoing assessments of assigned clients to document strengths, needs, goals and resources.
- Participates in the development/documentation /review and update of client centered comprehensive ,integrated, interdisciplinary care plan in consultation with other team members to ensure focus on desired outcomes.
- Maintains effective communications with clients, primary care physicians, substance abuse and mental healthcare providers, family, collateral resources and other Agency staff on behalf of clients.
- Maintains documents, records, statistics, and other related reports in an organized, timely and accurate manner as per policy and procedure.
- Coordinates care planning with other providers of services/ resources to ensure goal directed, collaborative care, including care transitions.
- Works as part of a Care Coordination team; attends and participates in team meetings to provide input/feedback around psychosocial and medical conditions conditions/comorbidities to review client status, update plans and goals, review outcomes to further program goals.
- Acts as a resources/consultant to all team members on psychosocial, medical and/or substance abuse issues and resources.
- Provides telephonic as well as face-to-face outreach, engagement and service planning in the field.
- Acts as a linkage to community services including medical, behavioral, residential, entitlement and any other needed services per interdisciplinary care plan.
- Monitors overall service delivery to clients to ensure coordination and continuity, advocates with service providers/resources are needed.
- Provides crisis intervention and follow-up.
- May be assigned other tasks and duties reasonably related to the job responsibilities.
SKILLS:
- For B.A. level candidates, (1) year of related human services experience required in providing direct services to mentally, developmentally or other disabled clients in order to link them to a broad range of services essential to successfully living in the community.
- 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.
- Experienced 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.
- You must have the ability and willingness to regularly travel, in some instances with clients in Agency vehicles, to many locations using various modes of reliable and safe transportation
REQUIREMENTS:
Bachelor's Degree or Master's Degree in Social Work, Psychology, or related field Degrees in other related areas may be considered.
BENEFITS:
- Competitive Salary
- Medical/Dental
- 401k (with company match)
- Profit Sharing
- Employee Referral Program
- Lunch and Learn Workshops
- Supplemental Benefits
- Paid Time off
- Holiday Pay
- Job Type: Full-time