Care Coordinator
 Resources For Human Development | |
21.63
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 United States, Pennsylvania, Bryn Mawr | |
 Jan 08, 2025 | |
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Description Job title Care Coordinator Reports to Clinical Supervisor/Assistant Program Director Why RHD? Hybrid- 2 days per week onsite Generous PTO Package! $1500 sign on bonus after 90 days of successful employment Opportunity for growth and development! Position Summary A Care Coordinator will function as the connection between the health care system and community resources to coordinate efforts that support the person in achieving their goals, improving their quality of life in the community. A Care Coordinator is responsible for working with LMCMS participants to increase and enhance their social and natural supports in the community to promote positive outcomes. Care Coordination is a person-centered approach that strives to meet the needs and preferences of individuals while strengthening the caregiving capabilities of families and service providers. This work not only improves the person's experience of care but can help improve health outcomes in collaboration with the rest of the team. Essential Duties and Functions * Organize care activities and share information with all relevant stakeholders around participants' care to achieve safer and more effective treatment outcomes. * Coordinate care across the spectrum of health services, including behavioral and physical health care, as well as social services, housing, educational systems, and employment opportunities as necessary to facilitate wellness and recovery of the whole person. * Collaborate with RHD programs and outside providers to coordinate care, to proactively identify individuals who have multiple or complex medical, social, and/or psychosocial needs, to advocate for individuals and their families, and to identify individuals who are at risk of developing complex needs during an acute episode of illness. * Serve as an educator of all stakeholders, including LMCMS staff and the community, regarding the care coordination process and specific health-related issues * Work with individuals in person, over the phone, and virtually to review and update their plan of care and progress towards their goals. Follow through on plans, address barriers and challenges together, and identify next steps before next contact. Conduct regular review and analysis of each individual's care to ensure they are linked with all available resources. * Coordinate treatment/discharge planning activities with individuals and hospital social workers for individuals admitted to inpatient care. This includes scheduling follow-up appointments, addressing barriers to those appointments, making sure the discharge plan is complete, and confirming availability of necessary supplies/medications. Complete clinical reviews of inpatient admissions to identify ways to prevent future hospitalizations. * Connect individuals with applicable resources through referrals and assess individuals' ability to follow through with skill development, advocacy, or other forms of tangible supports. * Review individual cases at weekly care coordination meetings to develop solutions to challenges and identify communication needed with internal/external team members. * Document care coordination activities in the Electronic Health Record and elsewhere as required[KC1] accurately, completely, and timely via progress notes, hospitalization logs, written reports, and shared documents. * Maintain a 48-hour standard for contact with individuals and external providers across all methods of communication. * Take on personal development and training opportunities. * Work on site, virtually, and in the community, as needed. * Maintain a 40-hour work week that may include occasional evenings or weekends. The daily schedule is to be arranged with the Integrated Health Manager and/or Care Coordination Supervisor. * Other duties as assigned. Integrated Health Addendum: * Support the focus of clinical staff on the delivery of medical care to maximize quality of life and ensure that care is provided in the most appropriate and supportive setting. * Coordinate with PH-MCO (Physical Health Managed Care Organization) on integrated healthcare initiatives to ensure individuals have completed annual physicals, recommended lab work, and other preventive screenings. * Partner with individuals, family members, and providers to ensure that the behavioral health team is supporting the work of the physical health provider to improve health outcomes. * Encourage independence while assisting individuals with identifying in-network healthcare providers and scheduling appointments. * Facilitate consultations between LMCMS prescribers and external providers to share medical records and review PDMP/test results. * Communicate outcomes of medical appointments and test results to the treatment team, as appropriate. * Co-facilitate with the LMCMS Nurse and document virtual and in-person health consultations and health education groups. * Represent LMCMS at interagency meetings and community events to promote integrated healthcare initiatives. * Participate in the development of new initiatives and approaches to support individuals with their whole health. Qualifications Required Qualifications * 2 years working in Community Mental Health and knowledge of local mental health systems. * Experience working with a multidisciplinary team, including psychiatrists, medical assistants, therapists, and mobile supports. * Experience working in an Outpatient setting preferred. * Valid driver's license and reliable mode of transportation. Must be willing to travel off site. * Proficient with Microsoft Office (Outlook, Word, Excel, PowerPoint). * Experience using an Electronic Health Record. * Comfortable making connections with local providers (hospitals, primary care/specialist offices). * Experience working with individuals with serious mental health diagnoses. * Team player, good communication skills, and strong time management skills. Required Education * Bachelor's Degree Required * Master's Degree in the Human Service field preferred Working conditions Hazard and Atmospheric Conditions
Additional Special Working Conditions:
Requirements Physical requirements Lifting Requirements
Physical Requirements
Reporting Relationships
Resources for Human Development is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, age, religion, gender, gender identity, sexual orientation, national origin, genetic information, veteran, or disability status. | |