Care Coordinator Bilingual Spanish

Person Centered Services•Rochester, NY

About The Position

The Bilingual Care Coordinator is responsible for coordinating all aspects of an individual’s care, including health and behavioral healthcare, community supports, and other services needed to meet the individual’s needs. For individuals enrolled in the health home, the coordinator takes a holistic approach using the core standards of service: comprehensive care management; care coordination and health promotion; comprehensive transitional care; individual and family support; referral to community and social support services; and use of health information technology to link services. The coordinator works with individuals, their circles of support, and service providers to develop and review person-centered Life Plans, support informed decision-making, and tailor services to individual needs. The role includes assessments, enrollment and eligibility paperwork, records and case-file maintenance, documentation and billing, provider collaboration, incident reporting and follow-up, and monitoring satisfaction and regulatory compliance. Services may be provided in individuals’ homes, provider offices, or other public places, and the coordinator may accompany individuals to appointments in accordance with policy. The coordinator is expected to provide quality-driven, cost-effective, culturally appropriate services and contribute to a respectful, just, and supportive environment aligned with the organization’s commitment to diversity, equity, and inclusion.

Requirements

Bachelor’s degree and 2 years of relevant experience, or a Licensed Registered Nurse credential and 2 years of relevant experience, or a Master’s degree and 1 year of relevant experience.
Valid New York State driver’s license; a valid driver’s license from a bordering state is acceptable for employment in New York if residing in that state.
Bilingual proficiency in English and Spanish.
Knowledge of developmental disabilities, chronic disease, and social determinants of health.
Strong knowledge of OPWDD-funded services and supports.
Experience with motivational interviewing.
Experience writing SMART goals.
Knowledge of person-centered planning regulations.
Ability to build relationships and communicate effectively.
Ability to encourage community integration and demonstrate cultural competence.
Ability to demonstrate ethical and professional responsibilities and boundaries.
Ability to use health information technology to link services and facilitate communication.
Knowledge of confidentiality regulations.
Organizational and time-management skills; ability to prioritize, approach professional responsibilities proactively, and complete work in a timely manner.

Responsibilities

Complete required assessments using person-centered planning techniques and incorporate other relevant assessments.
Develop a comprehensive, person-centered Life Plan with the individual, their circle of support, and their service provider team.
Support individuals in directing the planning process to the maximum extent possible and making informed decisions and choices.
Review the Life Plan with the interdisciplinary team at least annually and whenever a life-changing event occurs; the annual review must be face-to-face.
Coordinate all aspects of each individual’s care.
Manage a tiered caseload and tailor services to individual needs.
Complete program enrollment and eligibility documents.
Complete and secure consents and authorizations to share information.
Develop and maintain appropriate records.
Complete and review paperwork needed for case files and reports.
Complete documentation and billing in a timely manner.
Meet with individuals in their homes, physician or provider offices, and other public places to conduct assessments and provide services.
Accompany individuals to appointments in accordance with Person Centered Services policy.
Collaborate with providers and service support team members.
Initiate incident reports and follow up to ensure compliance with regulations.
Monitor individual satisfaction with supports and services.
Ensure case files comply with regulations and policy.
Provide quality-driven, cost-effective, culturally appropriate services.
Contribute to a respectful, just, and supportive environment for individuals and coworkers, aligned with the company’s commitment to diversity, equity, and inclusion.
Perform other related duties as assigned by the Care Coordinator Supervisor or Director of Care Coordination.