Treatment Care Coordinator

The Centers•Cleveland, OH

About The Position

Reporting to the East Clinical Director, the AOT Care Coordinator provides collaborative oversight of the agency’s Assistant Outpatient Treatment (AOT) program. The role links referring hospitals, agency staff, and probate court to coordinate client care. The coordinator completes mental health assessments for individuals referred to the AOT program and provides ongoing clinical counseling using evidence-based and trauma-informed approaches. The position coordinates hospital referrals and post-discharge follow-up, works with Cuyahoga County probate court and its AOT liaison, and collaborates with internal care teams to support clients and maintain continuity of care. It also coordinates treatment team meetings and recommitment processes. The role supervises Behavioral Health Specialist positions in coordination with the Program Manager. The job operates in a professional office environment. Travel and work outside normal hours may be required for meetings, presentations, trainings, and other events. Duties may change in accordance with organizational needs.

Requirements

Master’s degree in social work.
Active LSW license in the state of Ohio.
Experience working with clients with SPMI.
Knowledge of mental illness, substance use disorders, therapeutic modalities, and related community resources; strong clinical intervention skills.
Ability to communicate clearly and adapt language to the audience and situation.
Strong organization and time-management skills, including prioritizing work and setting goals and strategies.
Ability to contribute to shared goals, communicate openly with team members, ask for help when needed, and encourage involvement.
Ability to adapt to changing processes and use new technology to improve efficiency or work quality.

Responsibilities

Work with hospital systems to explain the AOT process and effective workflows for accessing internal services.
Coordinate hospital referrals and schedule and complete mental health assessments on hospital units.
Ensure required releases of information are completed to coordinate post-discharge care.
Stay in contact with hospital staff after assessments to confirm clients’ discharge dates and locations, and obtain discharge paperwork.
Complete a follow-up appointment with each AOT client within seven days of hospital discharge; monitor mental health status and educate clients about the AOT program.
Work with Cuyahoga County probate court and its AOT liaison, providing updates about program enrollment and case-management assignments after mental health assessments.
Coordinate with Center case managers and the AOT liaison to schedule and complete monthly status hearings for each AOT client.
Track AOT clients’ expiration dates and coordinate with psychiatry staff so recommitment letters are submitted at least 10 days before expiration.
Coordinate with Center staff and probate court to schedule recommitment hearings.
Coordinate and conduct treatment team meetings when there is uncertainty about whether a client should be recommitted to AOT.
Collaborate with internal staff working with AOT clients to help ensure clients do not fall through the cracks.
Assist with timely outreach to clients who miss appointments with their care teams.
Collaborate with local police districts when probate court submits orders of detention to help ensure timely issuance.
Provide mental health counseling using evidence-based and trauma-informed approaches.
Supervise Behavioral Health Specialist positions in coordination with the Program Manager.
Maintain accurate and appropriate records and documentation.