AOT/ Health Home Plus Care Manager
Buffalo Federation of Neighborhood Centers · Buffalo, NY, US
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About the Role
Provides person-centered services to assigned caseload of adult Assisted Outpatient Treatment (AOT)/HH+ consumers. Services include comprehensive assessment, care planning and coordination, outreach, crisis intervention, linkage to services, advocacy, and resource procurement. Performs recordkeeping, documentation, and quality assurance activities.
Responsibilities
- Provide outreach, engagement, and enrollment activities for referred AOT services.
- Conduct comprehensive assessment and service planning with AOT consumers.
- Manage caseloads of 12-15 persons, requiring a minimum of 4 face-to-face visits per month.
- Perform additional Care Management activities including mailings, electronic communications, and telephone calls with consumers, families, and community service providers.
- Develop, monitor, and update a comprehensive, individualized, consumer-centered Plan of Care integrating AOT plans with medical, behavioral health, rehabilitative, long-term care, and social service needs.
- Advocate, monitor health and medication adherence, arrange for/transport to medical appointments, connect to entitlements, facilitate vocational/educational goal support, recreation/leisure skill development, and assist with housing.
- Communicate with ECDMH or NYSOMH as needed for comprehensive servicing and timely reporting on AOT consumers.
- Work effectively within the AOT/HH+ Care Management Team to ensure 24/7 coverage.
- Maintain audit-ready charts with required assessments, service plans, and contact notes.
- Input and retrieve electronic data from various systems, including NYSOMH CAIRS.
- Respond promptly to communications related to consumers, internal correspondence, or external communications.
Requirements
- Possess a bachelor's degree in social work, psychology, nursing, rehabilitation, education, occupational therapy, physical therapy, recreation or recreation therapy, counseling, community mental health, child and family studies, sociology, speech and hearing, or other human services field.
- Alternatively, possess a NYS teacher's certificate requiring a bachelor's degree.
- Alternatively, possess NYS licensure and registration as a Registered Nurse with a bachelor's degree.
- Alternatively, possess a Bachelor's level education or higher in any field with five years of experience working directly with persons with behavioral health diagnoses.
- Alternatively, be a Credentialed Alcoholism and Substance Abuse Counselor (CASAC).
- Have two years of experience providing direct services to people with Serious Mental Illness, developmental disabilities, or alcoholism or substance abuse.
- Alternatively, have two years of experience linking individuals with Serious Mental Illness, developmental disabilities, or alcoholism or substance abuse to essential community living services.
- A master's degree in a qualifying education field may substitute for one year of experience.
- Must have use of an automobile and a valid driver's license.
Skills
- Ability to work independently and initiate change.
- Even temperament.
- Strong organizational and time management skills.
- Ability to work effectively within a team setting.
- Superior interpersonal skills for collaborating with providers and community support systems.
- Value cultural difference, collaborative efforts, and person-centered services.
- Excellent verbal and written communication skills.
- Strong negotiation skills.
- Strong judgment skills.
- Strong problem-solving skills.
Work Type
- Full-time
Experience Level
- 2 years of experience
Education Level
- Bachelor's degree
- NYS teacher's certificate
- NYS Registered Nurse license
- Master's degree
Salary/Compensations
- $22.50 Per hour