Senior Care Coordinator

CN Guidance and Counseling Services•Plainview, NY

About The Position

The Senior Care Coordinator is a member of an interdisciplinary team providing care coordination to adults with severe mental illness, multiple medical co-morbidities, and/or co-occurring substance abuse disorders. The role advocates for and supports clients, works with community agencies and health care providers to secure access to services, supports wellness self-management, and helps reduce emergency room visits and hospitalizations. The coordinator provides expert psychosocial and/or substance abuse support, interventions, and resources, with attention to outcomes and best practices. The position requires availability on an as-needed basis 24 hours a day, 7 days a week. The role involves field-based and telephonic outreach, client assessment and care planning, coordination with service providers, crisis intervention, and documentation. The coordinator also supports team members on psychosocial and substance abuse matters, attends AOT evaluations and court dates as needed, completes AOT monitoring reports, and coordinates with managed care organizations as needed. Regular travel is required, sometimes with clients in Agency vehicles. A bachelor's or master's degree in a relevant field is preferred; related fields may be considered. Candidates need related human-service and direct-service experience based on degree level, along with knowledge and skills in mental health services, interdisciplinary planning, documentation, entitlements, cultural competence, and collaboration. The employer offers a benefits package for full-time employees.

Requirements

Bachelor's or master's degree in a relevant field is preferred; degrees in other related areas may be considered.
For bachelor's-level candidates, two years of related human-service and direct-service experience are required.
For master's-level candidates, one year of related human-service and direct-service experience is required.
Experience providing direct services to individuals with severe mental health disorders, co-occurring substance abuse disorders, developmental disorders, and/or physical disabilities.
Experience linking clients to a broad range of services needed for independent community living and advocating for underserved or disenfranchised populations.
Working knowledge of computer software and electronic health record systems.
Demonstrated written, verbal, and computational skills to present and document records in accordance with program standards.
Experience and demonstrated comprehensive understanding of the interdisciplinary planning process and developmental treatment model.
Knowledge and sociological understanding of Medicaid, Social Security, and other social service entitlements.
Excellent interpersonal skills.
Knowledge of cultural competence and sensitivity.
Ability and willingness to travel regularly, sometimes with clients in Agency vehicles, using reliable and safe transportation.
For work in Nassau or Suffolk Counties, a valid New York, New Jersey, or Connecticut driver's license is required; a current valid license must be on file with CNGCS Human Resources, and the employee must be designated and remain in good standing as a CNGCS authorized driver.
Ability to be available for crisis intervention and follow-up on an as-needed basis 24 hours a day, 7 days a week.

Responsibilities

Conduct initial and ongoing assessments to document clients’ strengths, needs, goals, and resources.
Participate in developing, documenting, reviewing, and updating client-centered, comprehensive, integrated interdisciplinary care plans in consultation with the Program Supervisor and other team members.
Maintain effective communications with clients, primary care physicians, substance abuse and mental health care providers, family, collateral resources, and Agency staff on behalf of clients.
Maintain documents, records, statistics, and related reports in an organized, timely, and accurate manner in accordance with policy and procedure.
Coordinate care planning with other service and resource providers, including care transitions, to support goal-directed, collaborative care.
Participate in Care Coordination team meetings, providing input and feedback on psychosocial conditions and co-morbidities, client status, plans, goals, and outcomes.
Act as a resource and consultant to team members on psychosocial and/or substance abuse issues and resources.
Provide telephonic and face-to-face outreach, engagement, and service planning in the field.
Link clients to community services, including medical, behavioral, residential, entitlement, and other services identified in the interdisciplinary care plan.
Monitor service delivery for coordination and continuity, and advocate with providers and resources as needed.
Provide crisis intervention and follow-up as needed, 24 hours a day, 7 days a week.
Attend AOT evaluations and court dates as needed.
Complete weekly AOT monitoring reports for all clients.
Maintain the integrity of client records throughout the program.
Complete additional clinical assessments and coordinate care with managed care organizations as needed.
Facilitate sharing of relevant data with individuals to support partnered decision-making and keep clients informed of progress.
Complete QI training during onboarding and participate in refresher training as needed.
Cultivate an inclusive culture that respects employees’ individual strengths, views, and experiences.
Adhere to safety protocols and procedures and follow established safety guidelines.
Perform other duties as assigned.

Benefits

Medical insurance, including a $0-deductible Platinum Plus plan with 90% employer-provided benefit
Dental insurance
Vision insurance
Flexible Spending Account
403(b) retirement plan
Long-term and short-term disability
Legal plan
Dependent Care Expense Account
Life insurance and supplemental life insurance
Pet insurance
Health Reimbursement Arrangement (HRA)
Training programs, including a mentorship program
Potential eligibility for Federal/Public Student Loan Forgiveness
Career growth and promotional opportunities
Employee perks and discounts, including Broadway shows
5 personal days
10–20 vacation days
12 sick days
12 company-paid holidays annually