POSITION SUMMARY:

The Care Coordinator works in collaboration and partnership with persons experiencing serious disabling mental illness (SDMI), specifically consumers utilizing therapeutic group homes and assists in the provision of a service plan that links consumers to community resources and supports that promote successful community integration.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Serve as the contact point, advocate and informational resource for consumers, care team, family/caregiver(s), payers and community resources
• Work with consumers to plan and monitor care:
• Assess consumer’s unmet health and social needs
• Develop a care plan/treatment plan with the consumer, family/caregiver(s) and providers
• Monitor adherence to care plan/treatment plan, evaluate effectiveness, monitor patients progress in a timely manner and facilitate changes as needed
• Create ongoing processes for consumer and family/caregiver(s) to determine and request the level of care coordination support they desire at any given point in time
• Facilitate consumer access to appropriate medical and specialty providers
• Meet with consumer, family/caregiver(s) and care teams during times of crisis to determine best level of care. This may be done in the hospital or detention center
• Educate patient and family/caregiver(s) about relevant community resources
• Facilitate and attend meetings between consumer, family/caregiver(s), care team, payers and community resources as needed
• Cultivate and support primary care and specialty provider co-management with timely communication, inquiry, follow-up and integration of information into the care plan/treatment plan regarding transitions-in-care and referrals
• Assist in the identification of “high risk” consumers (the chronically mentally ill and those with specialty health care needs)

EDUCATION AND EXPERIENCE

• Must have a Bachelor's Degree in nursing, social work, psychology or a related human services field.
• Three years of progressively responsible experience working with individuals with SDMI in community behavioral health setting or equivalent.

MINIMUM QUALIFICATIONS

• Ability to pass background check and driver’s license check upon offer of employment.
• Must have valid Montana Driver’s License with an acceptable driving record.
• Provide proof of auto liability insurance coverage per Western’s policies.
• Montana Driver’s License with good driving record if required to transport clients while on work duty.