Care Manager

SPHS GROUP•Greensburg, PA

11d•Onsite

About The Position

Provides individualized, person-centered care management and engagement for high-risk, high-need individuals requiring crisis response, post-naloxone recovery referrals from first responders, and ongoing care to support continued engagement throughout the treatment and recovery process. Responsibilities include follow-up, community outreach, and continuity of care on a county-wide basis. Provides a holistic approach to care management, which will increase the quality of life of participants through education, engagement, assessment, and linkages to services and supports. Will collaborate closely with stakeholders, outside treatment and service providers to increase community-based supports and provide in-home supports as needed. Provides vision driven hope, encouragement, advocacy, support, and engagement to individuals through collaborative relationships with local hospitals, referrals from first responders, Recovery Care Organizations, physician offices, treatment programs, faith-based community programs, adult and juvenile probation, the county jail, the court system, recovery housing, Area Agency on Aging, and any other community-based organization. Will facilitate a comprehensive assessment that will be directed by the individual that will take a holistic approach to outline and prioritize the needs of the individual. Will work with individuals to develop an Individualized Service Plan which addresses the goals of an individual in respect to their needs and identifying available resources to achieve long term recovery and stabilization. The Service Plan will track progress, identify barriers, and address setbacks. Interventions utilized by the Community Based Care Manager will include, but not be limited to outreach and engagement, comprehensive assessment, motivational interviewing, accompaniment and warm handoffs, and follow-up. Initial engagement efforts will utilize face-to-face evidenced based interventions that include Motivational Interviewing and other rapport building strategies. Completes documentation in accordance with stakeholders, funding guidelines, regulatory standards, program policy and/or state project requirements. Participates in the On Call Rotation to provide 24/7 response. Assists clients in meeting their recovery goals by utilizing the phases of recovery: engagement, recovery initiation, recovery stabilization and sustained recovery maintenance. Provides outreach and educates consumers, family members and professional staff about the recovery process, the damaging role that stigma can play in understanding recovery and offers support related to obstacles that are often encountered during the recovery journey. Provides vision driven hope and encouragement regarding opportunities for varying levels of involvement in community-based activities (i.e., work, school, relationships, etc.), addressing their social determinants of health Responsible for data collection and tracking of referrals and activities utilizing the designated data collection tool. Adheres to all policies, laws, regulations and codes of ethics and confidentiality as outlined by federal and state laws, and agency policies and procedures.

Requirements

Associate degree in social work, chemical dependency, psychology, criminal justice or related human services field from an accredited college or university; OR any equivalent combination of experience and training.
Must be willing to obtain a Certified Recovery Specialist Certification through the Pennsylvania Certification Board AND a minimum of a High School Diploma or GED if self identifies personal experience with addiction recovery or co-occurring services.
Demonstrated ability to obtain vital information during an interview to make proper recommendations.
Demonstrated knowledge of financial entitlement programs and available social services.
Has basic computer skills commensurate with the position and ability to learn a computer based electronic health records system.
Must successfully obtain Criminal History Clearance from Pennsylvania State Police and Child Abuse Clearances from the Pennsylvania Department of Human Services and FBI Fingerprint Clearances.
Must not be excluded from participation in Medicare, Medicaid, or any other federal health care program.

Responsibilities

Provides a holistic approach to care management, which will increase the quality of life of participants through education, engagement, assessment, and linkages to services and supports.
Collaborates closely with stakeholders, outside treatment and service providers to increase community-based supports and provide in-home supports as needed.
Provides vision driven hope, encouragement, advocacy, support, and engagement to individuals through collaborative relationships with local hospitals, referrals from first responders, Recovery Care Organizations, physician offices, treatment programs, faith-based community programs, adult and juvenile probation, the county jail, the court system, recovery housing, Area Agency on Aging, and any other community-based organization.
Facilitates a comprehensive assessment that will be directed by the individual that will take a holistic approach to outline and prioritize the needs of the individual.
Works with individuals to develop an Individualized Service Plan which addresses the goals of an individual in respect to their needs and identifying available resources to achieve long term recovery and stabilization.
Tracks progress, identifies barriers, and addresses setbacks within the Service Plan.
Utilizes interventions including outreach and engagement, comprehensive assessment, motivational interviewing, accompaniment and warm handoffs, and follow-up.
Completes documentation in accordance with stakeholders, funding guidelines, regulatory standards, program policy and/or state project requirements.
Participates in the On Call Rotation to provide 24/7 response.
Assists clients in meeting their recovery goals by utilizing the phases of recovery: engagement, recovery initiation, recovery stabilization and sustained recovery maintenance.
Provides outreach and educates consumers, family members and professional staff about the recovery process, the damaging role that stigma can play in understanding recovery and offers support related to obstacles that are often encountered during the recovery journey.
Provides vision driven hope and encouragement regarding opportunities for varying levels of involvement in community-based activities (i.e., work, school, relationships, etc.), addressing their social determinants of health.
Responsible for data collection and tracking of referrals and activities utilizing the designated data collection tool.
Adheres to all policies, laws, regulations and codes of ethics and confidentiality as outlined by federal and state laws, and agency policies and procedures.