Care Coordinator - LTSS

CHD Careers•Northampton, MA

1d•$21

About The Position

The Center for Human Development (CHD) is seeking a Long-Term Support Services (LTSS) Care Coordinator to join our growing Innovative Care Partners (ICP) team. Through this program, help us improve health outcomes and quality of life for the enrollees throughout Northampton, MA and surrounding communities.â¯â¯ YOUR ROLE AS A CARE COORDINATOR: â¯ As a Care Coordinator, you will actively support the mission, purpose, philosophy and values of CHD/ICP and maintain a high level of professionalism and a commitment to our mission to improve the health outcomes/quality of life and reductions of cost of care to the population served. The Care Coordinator will provide evidence-based care coordination and management. ICP care coordinators ensure that more people within our communities can benefit from all exceptional health services.â¯â¯ Job duties: Collaborates with the Enrollee’s care team (registered nurse, PCP, PCA, medical director, behavioral health specialists, ACO’s, DMH, CBHI, CBHC, medical supply stores, social workers, etc.) Encourages Enrollee to follow treatment recommendations through support, health and wellness education, and advocacy. Links enrollees with resources and encourage them to use them to their advantage. Utilizes recovery strategies such as Motivational Interviewing, Harm Reduction and Strength Based approaches to support enrollees in attaining stated goals. Conducts visits in the home or in other locations in the community to provide guidance, support, education and coaching. Follow-up by telephone as necessary. Accompany/transport enrollees to medical/mental/behavioral health appointments as requested; facilitates effective navigation of the health care system LTSS Care Coordinators work with children ages 3 years old all the way up to adults who are 65 years old. Assists Enrollees in having an annual primary care visit. Completes Enrollee driven assessments, health screeners, Releases of Information and care plans annually. Complete daily activity notes in our electronic medical record. Ensures electronic medical record is up to date. Completes a face-to-face visit every 90 days. Ensures that Enrollee has an annual oral health evaluation. Participates in multi-disciplinary care team meetings. Ensures monthly contact with all enrollee's on caseload. Attends care team meetings, supervisions, Team meetings, MVP meetings, staff meetings, trainings, and various other meetings in regards to health care management. Manage a large caseload Transports enrollees to connect with local community resources and to attend healthcare appointments.

Requirements

Must have a vehicle available for work purposes that is registered and insured.
Must have a valid and active driver's license.
Must hold High School Diploma with 3 years of experience
Complete and pass background record screening process.

Nice To Haves

Bilingual candidates are encouraged to apply.
Bachelor's degree level applicants are encouraged to apply.
Our ideal candidate with be a dedicated and reliable Care Coordinator.
An independent self-starter with a willingness to advocate for participants.
In addition, candidates familiar with Northampton, MA and surrounding communities are encouraged to apply, as outreach is a key component of their role.
A strong, confident and unapprehensive approach to complete home visits and transportation of enrollees for connection with local community resources and to attend healthcare appointments.
Managing large caseloads with monthly contact with all enrollees.

Responsibilities

Collaborates with the Enrollee’s care team (registered nurse, PCP, PCA, medical director, behavioral health specialists, ACO’s, DMH, CBHI, CBHC, medical supply stores, social workers, etc.)
Encourages Enrollee to follow treatment recommendations through support, health and wellness education, and advocacy.
Links enrollees with resources and encourage them to use them to their advantage.
Utilizes recovery strategies such as Motivational Interviewing, Harm Reduction and Strength Based approaches to support enrollees in attaining stated goals.
Conducts visits in the home or in other locations in the community to provide guidance, support, education and coaching.
Follow-up by telephone as necessary.
Accompany/transport enrollees to medical/mental/behavioral health appointments as requested; facilitates effective navigation of the health care system
Assists Enrollees in having an annual primary care visit.
Completes Enrollee driven assessments, health screeners, Releases of Information and care plans annually.
Complete daily activity notes in our electronic medical record.
Ensures electronic medical record is up to date.
Completes a face-to-face visit every 90 days.
Ensures that Enrollee has an annual oral health evaluation.
Participates in multi-disciplinary care team meetings.
Ensures monthly contact with all enrollee's on caseload.
Attends care team meetings, supervisions, Team meetings, MVP meetings, staff meetings, trainings, and various other meetings in regards to health care management.
Manage a large caseload
Transports enrollees to connect with local community resources and to attend healthcare appointments.