Care Coordinator I, HIV & Prevention

POSITION: Care Coordinator I, HIV Testing & Counseling (649)
DEPARTMENT: Community Wellness
REPORTS TO: Program Manager II, HIV & Prevention
LOCATION: Native American Health Center, Inc.
160 Capp Street San Francisco, CA
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 care team who will work with providers across NAHC and other systems to provide NAHC clients with access to a holistic system of care. The incumbent will provide care coordination, case management, patient navigation, system navigation (internal and external), peer advocacy, health education, mapping individual, family and community supports and assets, intake (screening and assessments), and group and individual counseling services. The care coordinator may provide evidence-based treatments or work with other mental health providers when such treatment is indicated. The care coordinator may provide training and report writing, 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).
 

ESSENTIAL DUTIES AND RESPONSIBILITIES
1. Manage a diverse caseload of adults, youth, and families.
2. Screen and assess patients for common mental health and substance abuse disorders.
3. Facilitate educational groups on a weekly basis. Assist in conducting social service wellness education information group sessions and workshops.
4. Develops and implements individual plans of treatment using a culturally sensitive and strengths-based approach, to assist patients and families to cope and/or restore social, emotional, financial and environmental factors that affect and/or are affected by illness.
5. Monitor patients (in person or by telephone) for changes in clinical symptoms and treatment side effects or complications.
6. Responsible for Maintaining HEP-C and HIV Testing In alignment with NAHC policies.
7. Complete electronic and case management systems documentation related to mental health services in a manner that is both accurate and timely. Ensure completeness and accuracy of required data collection components.
8. Provide early intervention, direct services, and referrals, for clients, including children, adolescents and adults who have been exposed to trauma, mental health issues and/or substance use
9. Facilitate treatment plan changes for patients who are not improving as expected in consultation with the PCP, psychiatric consultant, and other mental health providers. These may include appropriate referrals for additional services.
10. Provide individual, group, and family crisis intervention and aftercare support when needed. Provide emergency services as needed, as well as ongoing case management which may include interacting with other NAHC departments, community agencies and staff.
11. Provide patient education about common sexual health and wellness, mental health and substance abuse disorders and available treatment options. Maintain the highest degree of confidentiality at all times.
12. Represent the program, department and agency in a positive and professional manner at all times.
13. Develop a shared understanding of the respective roles and responsibilities of team members to ensure that collaboration is efficient.
14. Plan and deliver services with an understanding of the healthcare needs of the population being served.
15. Work collaboratively to resolve differing perspectives, priorities and schedules among providers.
16. Connect healthcare consumers and family members to other members of the healthcare team through face-to-face encounters known as “warm hand-offs.” Use behavioral health and general health interventions to support the work of the team and to enhance healthcare consumer outcomes.
17. Clearly convey relevant information in a non-judgmental manner about behavioral health, general health, and health behaviors using person- centered concepts and terms that are free of jargon and a