About the Role
The Care Coordinator is responsible for coordinating all aspects of an assigned client's care, focusing on the integration and coordination of physical health and mental needs. This role ensures clients have access to necessary services, promotes self-management of health and wellness, and facilitates access to community-based resources.
Responsibilities
- Engage and retain consumers in care, coordinating and arranging continuous services.
- Support adherence to treatment recommendations and monitor client needs.
- Conduct a minimum of 2 face-to-face visits per month, or more based on client need.
- Reassess service needs and review clinical measurements, identifying and resolving barriers to care.
- Follow up on rehabilitative, long-term care, and social service needs.
- Identify and document primary care physicians, specialists, and other providers involved in a client's care.
- Promote wellness and prevention by linking consumers with resources for smoking cessation, diabetes, asthma, hypertension, and other medical services.
- Track and share consumer information and care needs across providers using an electronic database.
- Complete contact notes, incident reports, and other required documentation in a timely manner.
- Ensure consumers receive test results and follow up on medical directions.
- Assist consumers in understanding lab results, test results, and other reports impacting their health.
- Assess consumer needs to respond to emergency needs (e.g., clothing, food, shelter) and facilitate progress toward recovery goals.
- Provide services to prevent or resolve crises, ensuring crisis intervention service 24 hours per day, 7 days per week.
- Provide linkages with the Assisted Outpatient Treatment (AOT) Coordinating Team and maintain a system for tracking and monitoring consumers with AOT involvement.
- Aid consumers in identifying primary care physicians and multidisciplinary teams to ensure needed services are received.
- Maintain the security of all data files and employ approved methods of data encryption.
- Refer consumers to peer supports and coordinate support groups and self-care programs.
- Ensure timely and comprehensive transitional care from inpatient facilities to prevent readmissions.
- Communicate with staff regarding high-risk cases, linkage to providers, quality control, and documentation.
- Develop and maintain networks with medical practitioners, mental health providers, community organizations, and facilities.
- Schedule and provide logistical support for care team case conferences and track patient-provider follow-up actions.
- Ensure health home members’ entitlements, insurance, and benefits are in place.
- Provide interpreter services as required.
- Collaborate with program management in identifying and developing marketing strategies.
- Report issues that may negatively impact the agency, client, or staff welfare to administration.
- Cooperate with investigations conducted by the Agency, funding sources, and other authorized agencies.
Requirements
- Bachelor’s degree in social work, psychology, or a related health/human services field.
- Two years of direct work with the target population.
- Certification in a Health profession field.
- Skills in crisis assessment, clinical intervention, time management, organizational skills, and psychosocial rehabilitation.
- Ability to link clients to a broad range of services essential to living in a community setting.
- Cross-cultural competency, outreach, interviewing, listening, advocating, linking, negotiating, engagement, monitoring, and clinical assessment skills.
- Knowledge of community medical resources and their financial requirements.
- Good oral and written communication skills.
- Ability to travel in the community, including public transportation.
- Ability to work flexible hours and days, including weekends/evenings/holidays.
- Must be able to type and use a computer.
- Frequent sitting to write reports and meet with clients.
- Ability to read printed materials and computer screens.
Skills
- Crisis assessment
- Clinical intervention
- Time management
- Organizational skills
- Psychosocial rehabilitation
- Cross-cultural competency
- Outreach
- Interviewing
- Listening
- Advocating
- Linking
- Negotiating
- Engagement
- Monitoring
- Clinical assessment
- Oral communication
- Written communication
Location
- Brooklyn
- Queens
Work Type
- Full-time
- Onsite
Experience Level
- 2 years of direct work with the target population
Education Level
- Bachelor's degree in social work, psychology, or a related health/human services field
- Certification in Health profession field
Benefits
- Competitive salary
- Generous time off (Vacation/ Personal Days/ Sick Days/ Paid Holidays annually)
- Medical
- Dental
- Vision
- Retirement Savings with Agency Match
- Transit
- Flexible Spending Account
- Life insurance
- Public Loan Forgiveness Qualified Employer
- Training Series
- Additional voluntary benefits
About the Company
- 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.
- The Non-Medicaid Care Coordination Program works with individuals who do not qualify for Medicaid and are living with serious mental illness, to deliver comprehensive, community-based services and ensure clients have access to uninterrupted and coordinated behavioral and physical health services while addressing the social determinants of health that impact daily living.
Equal Opportunity
- EOE/AA
