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New Horizon Counseling Center Health Home Plus (HH+) Care Coordinator in Brooklyn/Queens, New York

The HH+ Care Coordinator functions as a member of an interdisciplinary team to provide care coordination to a caseload of severely mentally ill adults with multiple medical co morbidities and/or co-occurring substance abuse disorders. HH+ Care Coordinators advocate for and support the client, engage with community agencies/health care providers and others on his/her behalf to ensure access to services needed to increase wellness self-management and reduce emergency room visits and/ or hospitalizations.

  • Conduct appropriate screening and either performing or arranging for more detailed assessments when needed (e.g., high-risk substance use or mental health related indicators, harm to self/others, abuse/neglect and domestic violence).

  • Create and leverage relationships with critical behavioral health service providers to plan and coordinate care management needs for high-need SMI individuals including:

  • Navigating the mental health service system-including ability to make referrals to mental health housing services, crisis intervention/ diversion, peer support services

  • Knowledge of the behavioral health managed care benefit package and coordinating care with MCOs (e.g., for HARP members)

  • Collaborates with inpatient staff and MCO (as applicable) to affect successful transitions out of inpatient or institutional settings

  • Addressing the quality, adequacy and continuity of services to ensure appropriate support for individuals' mental health and psychosocial needs.

  • Maintain engagement with individuals who are often disengaged from care, have difficulty adhering to treatment recommendations, or have a history of homelessness

  • Develop service plans and resolve barriers to effective service utilization.

  • Accompany clients to/from any appointments when needed.

  • Document service information in databases and use electronic systems to track participant activities.

  • Assist in crisis intervention and provide or refer to crisis services.

  • Extensive field work required, including home visits and community work such as visiting hospitals and emergency rooms when determined necessary.

  • Ensure that clients follow-up with aftercare discharge (i.e. fill prescriptions, make appointments).

Skills and/or Experience Required:

  • For B.A. level candidates, two (2) years OR for M.A. level candidates, one (1) year of related experience working with individuals with severe mental illness.

  • Ability and willingness to regularly travel, in some instances with clients in Agency vehicles to many locations using various modes of reliable and safe transportation

  • You must have excellent interpersonal and time management skills.

  • Proficiency in email and documentation on electronic platforms.

  • Comfortable with fieldwork and navigating social services systems.

Preferred:

  • Knowledge of Medicaid, Social Security and other entitlements

  • Bilingual /Spanish a plus

  • Bilingual /Creole a plus

Benefits

  • Competitive Salary

  • Medical/Dental

  • 401k (with company match)

  • Profit Sharing

  • Employee Referral Program

  • Supplemental Benefits

  • Paid Time off

  • Holidays

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