Targeted Case Manager - Per Diem; 4155-505-H

Catholic Charities Brooklyn and Queens•New York, NY

About The Position

When you join the CCBQ Team, you will have an impact on the lives of many. For over 125 years, Catholic Charities Brooklyn and Queens has been providing quality social services to the neighborhoods of Brooklyn and Queens, and currently offers 160-plus programs and services for children, youth, adults, seniors, and those struggling with mental illness. Our Clinics are community-based which offer a professional and welcoming environment for both clients and staff. The Clinics provide psychotherapeutic and psychopharmacological therapy, as well as individual, group, family therapy, crisis intervention, medication management, case management and collateral sessions. Our staff members follow an approach to health care that emphasizes wellness, recovery, trauma-informed care, and physical-behavioral health integration. Under the direct supervision of the Clinical Director, the Targeted Case Manager (TCM) will play a pivotal role within the integrated care ecosystem of the Certified Community Behavioral Health Clinic (CCBHC). Under the SAMHSA grant, the TCM will be part of a specialized team embedded in the CCBHC, targeting services for a high-risk behavioral health population being served under CCNS. The TCM team will adhere to specific SAMHSA regulations and requirements regarding the frequency, scope and duration for working with clients under a Critical Time Intervention model. The CCBHC is based on an initiative to expand Americans’ access to mental health and addiction care in community-based settings. CCBHCs are responsible for providing the following types of services: crisis mental health services; screening, assessment and diagnosis, including risk assessment; patient-centered treatment planning; outpatient mental health and substance use services; primary care screening and monitoring of key health indicators/health risk; targeted case management; psychiatric rehabilitation services; peer support and family supports; intensive, community-based mental health care for members of the armed forces and veterans. Under the CCBHC model, the Targeted Case Manager (TCM) will work in conjunction with the CCNS CCBHC clinics and will coordinate care across settings and providers to ensure seamless transitions for clients across the full spectrum of health services, including acute, chronic, and behavioral health needs. Duties of the TCM focus on the integration of the care team to serve the client in any appropriate need-based area, including mental health, medical issues, social determinants of health, substance use issues, psychosocial needs, food insecurity, housing instability. The TCM is responsible for high quality targeted case management services that will assist individuals in sustaining recovery, and gaining access to needed medical, social, legal, educational, and other services and supports.

Requirements

Bachelor’s degree in social work, psychology, or a related health/human services field with two (2) years of direct work with the target population. OR Professional Degree/certification in healthcare field.
The position requires a combination of skills in the areas of crisis intervention, time management, psychosocial rehabilitation skills.
Ability in linking clients to a broad range of services essential to successfully living in a community setting (e.g., medical, psychiatric, social, educational, legal, housing and financial services). Must have excellent communication skills.
Cross-cultural competency, outreach, interviewing, listening, advocating, linking, negotiating, engagement, monitoring and clinical assessment skills are essential.
Excellent computer skills are necessary.
Knowledge of the community medical resources and their financial requirements.
Good oral and written communication skills.

Nice To Haves

Fluency in second language preferred

Responsibilities

In conjunction with interdisciplinary team, is accountable for engaging and retaining client in care, arranging for the continuous provision of services, supporting adherence to treatment recommendations, monitoring, and evaluating client needs, including prevention, wellness, medical, specialist and behavioral health treatment, care transitions, and social and community services where appropriate through the creation of an individual plan of care.
Coordinate care across the spectrum of health services, including access to high-quality physical health (both acute and chronic) and behavioral health care, as well as social services, housing, educational systems, entitlements/benefits, and employment opportunities as necessary to facilitate wellness and recovery of the whole person.
Aid CCBHC clients in identifying the primary care physician and multidisciplinary teams of medical, mental health, chemical dependency treatment providers, social workers, nurse’s nutritionists/dieticians, pharmacists, outreach workers including peer specialists and other care providers to assure that enrollees receive needed medical, behavioral, and social services in accordance with a plan of care.
Refer CCBHC clients to peer supports, support groups, and self-care programs to increase client’s and caregivers’ knowledge about the individual’s diseases; promote client’s engagement and self-management capabilities in their participation in care plan development and decision making.
Complete progress notes, incident reports, and other required documentation and maintain accurate recordings in electronic case files in a requested timely fashion.
Assure timely and comprehensive transitional care from an inpatient facility (hospital, rehabilitative, psychiatric, skilled nursing, or treatment facility) to follow-up with post discharge interventions; transition/escort clients from inpatient settings back to the community and be an active leader in discharge planning with hospital teams- able to respond in person to hospitals upon learning a client is hospitalized.
As this is an evolving program, additional responsibilities may be added and/or revised.