What are the responsibilities and job description for the Clinical Care Coordinator position at New England Center and Home for Veterans?
Description
Position Title: Clinical Care Coordinator
Department: Human Services Department
Exemption : Non-Exempt
Supervisor: Clinical Director
Job Summary
As part of the Veteran 360 Behavioral Health Programs, provide community-based case management services for Veterans experiencing homelessness with serious mental illness, substance use disorders, and/or complex medical illnesses. Link Veterans to needed care including mental health, substance use, and primary care as well as services that address social determinants of health. This role is a part of a MassHealth initiative that provides qualified MassHealth enrollees with a service benefit called Behavioral Health Community Partners (BH CP). This initiative is led by the Boston Health Care for the Homeless Program, who has partnered with community-based providers to form the Social Determinants of Health BH CP Consortium to serve eligible MassHealth enrollees in the greater Boston area.
Job Responsibilities
Required Qualifications:
Position Title: Clinical Care Coordinator
Department: Human Services Department
Exemption : Non-Exempt
Supervisor: Clinical Director
Job Summary
As part of the Veteran 360 Behavioral Health Programs, provide community-based case management services for Veterans experiencing homelessness with serious mental illness, substance use disorders, and/or complex medical illnesses. Link Veterans to needed care including mental health, substance use, and primary care as well as services that address social determinants of health. This role is a part of a MassHealth initiative that provides qualified MassHealth enrollees with a service benefit called Behavioral Health Community Partners (BH CP). This initiative is led by the Boston Health Care for the Homeless Program, who has partnered with community-based providers to form the Social Determinants of Health BH CP Consortium to serve eligible MassHealth enrollees in the greater Boston area.
Job Responsibilities
- Work as part of an interdisciplinary BH CP team and coordinate the care for enrollees. Work closely with nurse care managers to engage enrollees regularly (several times a month) in face to face interactions to assist them in connecting to vital services and progress towards the goals outlined in their Person-Centered Care Plan.
- Work with the nurse care managers to conduct timely Comprehensive Assessments.
- Maintain weekly communication with the BH CP team via data sharing platform to improve coordination of information sharing/collaboration between enrollee and BH CP teams.
- Ensure timely documentation into data platform regarding enrollee progress on Care Plan goals, all enrollee encounters and care coordination notes.
- Assist nurse care managers and BH CP teams with arranging enrollee appointments for services needed and other related assessments and accompany enrollees to appointments as needed.
- Triage and troubleshoot care need issues for enrollees and work with nurse care managers to address needs.
- Participate in team case conferences and advocates for enrollees’ needs.
- Participate in BH CP training and learning collaborative.
- Remind enrollees about appointments, filling prescriptions, etc.
- Work with BH CP team on the development and implementation of Patient Centered Care Plan.
- Request and send medical records for care coordination purposes to providers, Accountable Care Organization and Managed Care Organizations as needed.
- Collaboration with both community and medical partners to coordinate care services to meet participant need.
- Attend staff trainings and meetings as required.
- Provide referrals or assistance linking to community-based services and benefits
- Perform other duties as assigned or as they may arise.
Required Qualifications:
- BA in Human Services related field.
- Two years’ experience with Veteran population, chronic mental illness, substance use disorders, and/or homelessness.
- Excellent customer service skills and the ability to communicate professionally with employees and enrollees both on the phone and in person.
- Proficiency with database systems.
- Strong crisis intervention skills.
- Case management experience preferred.
- Flexible self-starter with strong analytical skills.
- Experience with Motivational Interviewing, Harm Reduction, Cultural Competency and Trauma Informed Care preferred.
- Knowledge of services in the greater Boston community.
- Knowledge of military culture.
- Must be able to travel in the greater Boston area.
- Ability to work comfortably with a multicultural, homeless population experiencing complex challenges.
- Must be able to work independently
- Comfort conducting home visits and in the community
- Strong organization skills.
- Strong computer, database and electronic recording keeping skills.
- Ability to maintain professional and personal boundaries.
- Ability to write clear progress notes and person-centered service/care plans.
- Strong written and oral communication skills.
- Ability to work collaboratively with clinical teams, other Center programs and departments.
