High Intensity Case Manager (RISE Guide)

firsthand Health•Richmond, VA

25d•Hybrid

About The Position

firsthand supports individuals living with SMI (serious mental illness) through a holistic approach involving peer recovery specialists, benefits specialists, and clinicians. The company focuses on meeting individuals where they are, acting as trusted guides to support their journey to better health. firsthand utilizes lived experience to build trust and help individuals reconnect with necessary healthcare while minimizing inappropriate utilization. The company aims to change how society supports those most impacted by SMI. They are seeking passionate problem-solvers to address complex healthcare challenges, offering a role with purpose, motivated colleagues, and an environment that fosters learning, creativity, and fun. The RISE Guide role is specifically for supporting individuals who require the highest level of care, often involving multiple engagements per week or day, and is performed in the community.

Requirements

Empathy, compassion, and approachability
Excellent listening, communication, and interpersonal skills
Personal knowledge of recovery and/or behavioral health
Patience, persistence and a desire to help individuals experiencing SMI and/or SUD on their wellness journey
Comfort working collaboratively within multidisciplinary teams, including clinicians
Comfort or willingness to be an advocate for individuals in acute healthcare settings such as ERs and hospitals.
Strong personal boundaries and the ability to navigate high-stress situations while maintaining a calm, grounded presence
Demonstrated mastery with technical tools like smart phones, email, messaging services, and apps
Openness to receiving feedback and a commitment to professional growth
Lived experience with SMI and/or SUD and recovery
Two (2) years demonstrated recovery time from a mental health and/or substance abuse disorder at the date of application
Agreement to complete a paid training period prior to serving individuals and pass assessments to move forward
Interest in gaining a Community Health Worker (CHW) Credential after hire, or already holds certification
Training or experience in de-escalation techniques (e.g., CPI, Mental Health First Aid) or a willingness to be trained in these methods

Nice To Haves

Certified Case Manager (CCM) Certification
Experience with direct in-person engagement for individuals with SMI and SUD
Expertise in recovery education and coaching
Understanding of whole health and trauma-informed approaches to peer support
Familiarity with local community resources, behavioral health systems, and the criminal justice system (e.g., mental health and drug courts)
Ability to thrive in a mobile environment, spending 80%+ of your time in the community (homes, hospitals, streets) rather than an office
Eagerness to expand knowledge about a broad range of health conditions
Valid driver’s license in good standing, with the ability to operate a vehicle (company vehicle may be provided) and eligibility to drive under the company’s insurance policy

Responsibilities

Support a small, high-touch panel of individuals, providing comprehensive hybrid support (in-person and virtual) tailored to complex acuity levels.
Provide intensive post-discharge management and transitions of care, ensuring stability post psychiatric hospitalization and supporting them, ideally with in-hospital engagement and discharge planning.
Coordinate and support their Substance Use Disorder treatment plan, if applicable.
Support individuals in navigating their relationship with medications, including identifying and addressing barriers to adherence and facilitating communication with their prescribing team.
Develop a deep understanding of the individual’s supports and triggers for deterioration, and be able to quickly develop safety & action planning to support them.
Co-navigate systemic barriers alongside individuals to ensure they are able to access care, including appointments, transportation, enrollment into care services, and more.
Actively problem solve and own to resolve social challenges, such as housing, food, transportation.
Participate in daily huddles and regular IPRs to ensure a coordinated approach for RISE individuals.
Potentially participate in (Post-Pilot) after-hours rotation to support individuals experiencing a crisis or urgent need outside of standard business hours.
Maintain engagement and build a trusting relationship with their individual, supporting them with empathy and assistance with problem solving.
Support our individual, and our broader RISE care team, with ensuring our individuals avoid any sentinel, traumatic events – leading to better clinical outcomes and quality of life.