Care Coordinator-CN536501

ICL Inc.New York, NY
Hybrid

About The Position

The Children’s Care Coordinator functions as a member of an interdisciplinary team to provide care coordination to a caseload of seriously emotionally disturbed children with multiple medical comorbidities and/or co-occurring trauma disorders and/or children with HIV. Advocates for and supports the member and possibly their family, engages with community agencies/health care providers and others on his/her behalf to ensure access to services needed to increase wellness self-management and reduce emergency room visits and/ or hospitalizations.

Requirements

  • 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.
  • Excellent interpersonal skills.
  • Ability to regularly travel throughout all five boroughs using an agency vehicle if authorized, public transportation, or other means of transportation as appropriate.
  • A bachelor’s degree in one of the fields listed below1; or
  • A NYS teacher’s certificate for which a bachelor’s degree is required; or
  • NYS licensure and registration as a Registered Nurse and a bachelor’s degree; or
  • A Bachelor’s level education or higher in any field with three years of experience working directly with persons with behavioral health diagnoses; health homes, care management or
  • A Credentialed Alcoholism and Substance Abuse Counselor (CASAC).
  • AND two years of experience:
  • In providing direct services to people with Serious Mental Illness, developmental disabilities, or substance use disorders; or
  • In linking individuals with Serious Mental Illness, developmental disabilities, or substance use disorders to a broad range of services essential to successful living in a community setting (e.g. medical, psychiatric, social, educational, legal, housing and financial services).
  • Specific training for Health Home Serving Children must be completed within 30 days of hire.

Nice To Haves

  • Knowledge of Medicaid, Social Security and other entitlements preferred.
  • A master’s degree in one of the qualifying education fields may be substituted for one year of experience.

Responsibilities

  • Conducts initial and ongoing comprehensive assessments and care plans of assigned members to assess needs, create goals and link to resources.
  • Provides coordination support through consultation, education, interventions, safety planning, and linking to resources to maintain focus on outcomes and best practices.
  • Participates in the development/documentation/review of care plan in consultation with other care team members to ensure focus on desired outcomes.
  • Use team-based communication strategies to close the loop on referrals, hospital follow-ups and any outstanding items identified in the member’s care plan.
  • Maintains effective communications with members, primary care physicians, substance abuse, and mental healthcare providers, family, collateral resources and other agency staff on behalf of members.
  • 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.
  • Attends and participates in team meetings to provide input/feedback around psychosocial and medical conditions conditions/comorbidities to review member status, update plans and goals, review outcomes to further program goals.
  • Acts as a resource/consultant to all team members on psychosocial, medical and/or substance abuse issues and resources.
  • Performs outreach activities in primary care sites, homes, hospitals, and neighborhoods.
  • 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 ensure coordination and continuity; advocates with service providers/resources as needed.
  • Provides crisis intervention and follow-up.
  • May be assigned other tasks and duties reasonably related to the job responsibilities.
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