Care Coordinator - Full-time, 4401-204-N
Catholic Charities Brooklyn and Queens
- Brooklyn, NY
- Permanent
- Full-time
- Accountable for engaging and retaining individuals in care, coordinating and arranging for the continuous provision of services, supporting adherence to treatment recommendations, monitoring and evaluating their needs, including prevention, wellness, medical, specialist and behavioral health treatment, care transitions and social and community services where appropriate through the creation of an individual plan of care.
- In collaboration with the client, their family and/or caregivers, and other service providers develops, manages and coordinates a comprehensive individualized person-centered care plan that coordinates and integrates the continuum of medical, behavioral health services, rehabilitative, long term care and social service needs and clearly identifies the primary care physician/nurse practitioner, specialists, behavioral health care providers, care manager and other providers directly involved in the individual’s care.
- Ensures the availability of priority appointments for clients to care services including physical, psychiatric, and substance use within their provider network to avoid unnecessary, inappropriate utilization of emergency room and inpatient hospital services.
- Promotes evidence-based wellness and prevention by linking health home members with resources for smoking cessation, diabetes, asthma, hypertension, self-help recovery resources and other medical services based on individual physical needs and preferences.
- Tracks and shares client information and care needs across providers by utilizing electronic databases and monitors outcomes and initiate changes in care, as necessary, to address client needs.
- Reassesses needs for services and reviews clients’ historical or targeted clinical measurements (i.e. number of ER visits and inpatient psychiatric admissions).
- Identifies potential barriers to successful care and resolutions to those barriers.
- Completes contact notes, incident reports, and other required documentation and maintains accurate recordings in electronic case files.
- Bachelor’s degree in social work, psychology, or a related health/human services field with 2 years of direct work with the target population or Degree/Certification in Medical and Clinical Assistance or Health Professional field.
- Combination of skills in the areas of crisis intervention, time management, and psychosocial rehabilitation skills.
- Ability in linking clients to a broad range of services essential to successfully living in a community setting (e.g. medical, psychiatric, social, educational, legal, housing and financial services).
- Must have excellent communication skills.
- Cross-cultural competency, outreach, interviewing, listening, advocating, linking, negotiating, engagement, monitoring and clinical assessment skills are essential.
- Knowledge of community medical resources and their financial requirements.
- Excellent computer skills.
- Ability to read and write in English
- Knowledge of computer programs (MS Word, Excel, PowerPoint, & Outlook).
- Good communication skills. • Knowledge of the second language is preferred (Spanish, Russian, Creole, Cantonese).