Care Coordinator

Make a bigger difference

All Staten Island programs are allotted a $4,420 commuter differential that is applicable to anyone who currently works or is hired to work on Staten Island who doesn’t live in Staten Island in addition to the base salary or hourly wage.

Purpose:

Care Management is a service that helps children with chronic physical or emotional issues obtain and utilize the medical, social and community services they need to get and stay healthy. Care Coordinators learn all they can about the child and family's unique needs. They work with other care providers to develop a plan of care and help members determine and take the actions needed to make and keep appointments, adhere to medications, obtain educational and health advocacy, and access benefits.

Position Overview:

Care Coordinators link children who have chronic medical or behavioral health conditions to the services they need to stay as healthy as possible and avoid unnecessary trips to the emergency room. Care coordinators encourage the clients (members) they serve to use those services to optimize their health outcomes. Working in a team setting and primarily in the field, Care Coordinators assess risks and needs, develop person centered care plans, track and arrange appointments, educate members and coordinate other aspects of members' health and community services. Requires some evening availability with the role. Additional responsibilities will be added.

RESPONSIBILITIES include but NOT limited to:

o Integration of medical, specialized and behavioral health services in addition to social support and/or educational support services.

e Periodic assessment of a member's medical and behavioral health needs as well as their compliance with recommended treatments.

• Collaborative development of an Individualized Plan of Care with the member, the member's family and/or caregivers in addition to other service providers.
• Conduct and document outreach efforts for new referrals to facilitate enrollment conversions.
• Provide care management services, ensuring members access and retain needed services as outlined in their care plans, including Acute and Primary Medical Care, Preventative Medical Care (including metabolic screening), Home Health Care, Chemical Dependency Services, Behavioral Health Services, Community Social Support Services, Housing, State and Federal Entitlements, Educational Services, and involvement with child welfare, juvenile justice, or criminal justice institutions.
• Tracking all specialty medical, behavioral and support service referrals made for patient using Health Information Technology (HIT) and other electronic databases required.
• Monitor appropriate discharge and ongoing care planning at pre- and post-transition for individuals transitioning to community.

e Establish collaborative relationships and serve as a liaison with community providers, Managed Care Plans, schools, and medical providers.

e Complete casework documentation promptly as required, maintaining adherence to productivity standards. o Attend and participate in program meetings and weekly supervisory sessions as scheduled.

• Provide referrals and reassess members' need for ongoing care coordination to ensure access to necessary services.

 Sharing knowledge and experience with other team members to support the team's overall service provision efforts.

• Carrying an agency-provided cell phone, laptop and hotspot for hybrid use.

' Respond to members^t questions, needs, and crises during regular and after business hours via the program's emergency cell phone, which is rotated among care coordinators.

 Perform other duties as assigned

EDUCATIONAL / TRAINING REQUIRED (List all that is required to achieve this position):

A Bachelor's Degree with a major or concentration in social work, psychology, nursing, rehabilitation, education, occupational therapy, physical therapy, recreation therapy, counseling, community mental health, child and family studies, sociology, or speech and hearing PLUS Two years of experience in providing direct services, or a substantial number of case management services, to mentally disabled or chronically ill or homeless children with complex social or healthcare needs.