The Care Coordinator functions as a member of an interdisciplinary team to provide care coordination to a caseload of severely mentally ill adults with multiple medical co morbidities and/or co-occurring substance abuse disorders. Advocate for and support the client, engage with community agencies/health care providers and others on his/her behalf to ensure access to services needed to increase wellness self-management and reduce emergency room visits and/ or hospitalizations.

Responsibilities:

• Provide clinical support to the Team by providing consultation, education information around conditions, interventions, resources to maintain focus on outcomes and best practices.
• Conduct initial and ongoing assessments of clients to document strengths, needs, goals and resources.
• Follow up with hospital care teams during admissions and discharges to facilitate discharge planning and arranging outpatient follow-up
• Assist with applications for benefits such as SNAP, SSI/SSD, HEAP
• Identify and address social determinants of health such as: food insecurity, transportation, housing
• Provide face-to-face outreach, engagement and service planning in the field.
• Act as a linkage to community services including medical, behavioral, residential, entitlement and any other needed services per interdisciplinary care plan.
• Provide crisis intervention and follow-up.
• Maintain documents, records, and other related reports in an organized, timely and accurate manner as per policy and procedure.
• May be assigned other tasks and duties reasonably related to the job responsibilities.

Requirements:

Bachelor's Degree in one of the following fields:

Social Work, Psychology, Education, Rehabilitation, Occupational Therapy, Counseling, Community Mental Health, Sociology, Physical or Recreational therapy. Degrees in other related areas may be considered.

Experience:

• One (1) year of related human services experience required in providing direct services to clients diagnosed with severe mental illness, HIV/AIDS or other disabilities, in order to link them to a broad range of services essential to successfully living in the community.
• You must have the ability and willingness to regularly travel, in some instances with clients in Agency vehicle to many locations using various modes of reliable and safe transportation
• You must have excellent interpersonal and time management skills.

Preferred:

• Knowledge of Medicaid, Social Security, and other entitlements
• Bilingual (Spanish)

Benefits:

• Competitive Salary
• Medical/Dental
• 401k (with company match)
• Profit Sharing
• Employee Referral Program
• Lunch and Learn Workshops
• Supplemental Benefits
• Paid Time off
• Holiday Pay

Job Type: Full-time