Field Based Clinical Care Coordinator - Tippecanoe County, IN

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As part of a care management team who will manage complex members, the Integrated Care Coordinator will be the primary care manager for a panel of older adult members with a variety of medical and/or behavioral health needs. Care coordination activities will focus on supporting members' medical, behavioral, and socioeconomic needs to promote appropriate utilization of services and improved quality of care. 

Work Schedule: Monday through Friday 8:00 am to 5:00 pm

Location: Tippecanoe County, Indiana and surrounding areas

Local travel up to 75% and mileage is reimbursed at current government rate.

If you live within the state of Indiana and can travel to Tippecanoe County, IN and surrounding counties, you will have the flexibility to telecommute* as you take on some tough challenges. 

Primary Responsibilities:

• Serve as primary care manager and service coordinator for high medical risks / needs members with comorbid behavioral health needs
• Engage members face-to-face and/or telephonically to complete comprehensive needs assessment, including assessment of medical, behavioral, functional, cultural and socioeconomic (SDoH) needs 
• Develop and implement individualized, person-centered care plans and service plans inclusive of goals, opportunities and interventions/services aligned with a person's readiness to change to support the best health and quality of life outcomes by meeting the members where they are 
• Partner and collaborate with internal care team, providers, and community resources/partners to implement care plan 
• Provide referrals and linkage as appropriate and accepted by members (may include internal consulting opportunities such as Housing Navigator, Pharmacy Team, Peer Specialist, etc. or community-based provider referrals such as PCP, specialists, medication assisted therapy referrals, etc.)  

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• Must Possess One of the Following: 
  • Master's Degree in Social Work 
  • Bachelor's Degree in Social Work, Psychology, Special Education, Counseling, or relevant degree with at least 1+ years of case management experience with older adults, individuals with disabilities or those with serious mental illness
• 2+ years of experience in long-term support services or working with older adults
• 1+ years of experience with local behavioral health providers and community support organizations addressing SDoH (e.g., food banks, non-emergent transportation, utility assistance, housing/rapid re-housing assistance, etc.)
• 1+ years of experience with MS Office, including Word, Excel and Outlook 
• Ability to travel 75% of the time within assigned territory to meet with members and providers
• Reside in Indiana
• Access to reliable transportation & possess a valid US driver's license

Preferred Qualifications:

• Demonstrated experience/additional training or certifications in Motivational Interviewing, Stages of Change, Trauma-Informed Care, Person-Centered Care
• Experience working in team-based care
• Experience in serving individuals with co-occurring disorders (both mental health and substance use disorders)
• Background in Managed Care
• Bilingual in Spanish or other language specific to market populations

Physical Requirements

• Ability to transition from office to field locations multiple times per day 
• Ability to naviga