Care Coordinator

Description

Summary/Objective: 

By working with the eligible members, their families/supports, and a network of provider agencies, the Care Coordinator provides comprehensive and person-centered care coordination and care management services for members experiencing emotional and/or behavioral problems or those with complex combinations of chronic conditions/serious mental illnesses. CHJC and its dedicated Care Coordinators strive to improve the responsiveness, accountability, and navigation of the complex medical, behavioral, and social service system. 

The Care Coordinator is responsible for conducting strength-based assessments, identifying and submitting referrals for needed services/community supports, and providing advocacy and support to individual members. To ensure the member receives quality services and maintains optimum healthcare without barriers, the Care Coordinator communicates with each member and their care team. Services are provided by a comprehensive network of provider agencies, delivering an array of medical, self-help, social, supportive, and rehabilitative services. Based on the individual needs of the member, individualized service plans are developed.

Essential Functions:

1. Assist members to identify strengths and develop problem solving strategies to further enhance those strengths

2. As determined by the individual member’s need, assist in the seamless transition to higher or lower levels of care

3. Ensure the delivery of high intensity care management services to members

4. Assist members to access various community services available

5. Beginning with a strength-based assessment, in collaboration with the member, family members and service providers, develop individualized service plans for each member

6. Taking an integrated approach to service planning and delivery, provide wraparound services and a service plan tailored to the member’s need

7. To minimize emergency room visits and subsequent hospitalizations, within one business day, follow-up/connect with the member to insure follow up care is scheduled and provided and any referrals to community resources is completed. 

8. Responsible to maintain accurate records in the designated EMR, completes assessment and documentation timely, professionally, and accurately

9. Ensures eligibility and appropriateness for enrollment and continued enrollment

10. Collaborates with all members of the care team; schedules and facilitates Team Meetings

Special Requirements:

Work Environment: Office environment will require occasional travel to recruitment events, local schools, conferences and/or meetings and travel within the community to include off-site/remote. May have contact with service recipients that are agitated and/or are in crisis. Some risk involved working with service recipients with mental illness. Works in an office setting with a controlled temperature environment. Occasional exposure to inclement weather conditions may occur depending upon assignments. 

Equipment: This position is required to maintain a working knowledge of related office equipment including personal computers and printers, audio-visual equipment, telephone systems, copiers, fax machines, etc.

Physical Demands: Must be able to sit, stand, walk, lift, carry, push/pull, climb, bend, and stoop. Must be able to perform fine motor skills, read, and type. Must be able to sit for long periods of time. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Position Type/Expected Hours of Work:

Full-time, traditional hours required along with non-traditional hours. This position is required to work on-site, and offsite/remote. Must participate in the on-call rotation. 

Travel:

Travel is required throughout service area (Jefferson, Lewis, Oswego, and St. Lawerence County).

Required Education and Experience: 

An Associate’s Degree in psychology, sociology, human services, or related field is required; a Bachelor’s Degree is strongly preferred. With proper relevant experience, licensure, or certification in a related field such as LPN or CASAC may be substituted for Associates Degree. 

Requirements

Skills/Abilities/Knowledge:

Strong organizational abilities and office skills are essential for this position. This person must also have excellent people skills and be a team player. Ability to work with diverse populations. Must demonstrate effective and excellent oral and written communication skills and the ability to work cooperatively with others. Must be detail-oriented and possess excellent time-management skills. Requires self-direction, tact, diplomacy, and the abili