Care Coordinator - Guidance Center of Lea County : Job Details

POSITION SUMMARY CareLink NM is a Medicaid-funded care coordination program. CareLink is intended to enhance integration and coordination of primary care, behavioral health care, acute care, and long-term care services for individuals with a serious mental illness diagnosis along with a chronic physical health diagnosis. CareLink NM services include comprehensive needs assessment and individualized care plan; care coordination; prevention, health promotion, and disease management; comprehensive transitional care; individual and family support service; and referrals to community and social support services. RESPONSIBILITIES

Carry a minimum caseload of 80 individuals at a time

Complete a monthly billable encounter with at least 90% of assigned caseload

Contact eligible individuals to provide education and orientation about CareLink services, and obtain and document the individual decision's about opting-in to CareLink

Conduct Comprehensive Needs Assessment (CNA)

Create an integrated service plan based on the CNA with the enrolled individual

Create crisis and disaster plans with enrolled individuals

Conduct a minimum of one encounter per month per client that supports the individual's progress towards service plan goals

Perform all care coordination activities as needed

Maintain clear, concise, and timely documentation adhering to all policies and procedures

Document client interactions and encounters in the GCLC electronic health record, the State of New Mexico's NMSTAR system, and internal spreadsheets

Maintain all client charts following the CareLink Policy Manual and GCLC requirements

Function as the hub for the individual's care team developed in collaboration with the individual, their natural supports, and as informed by the CNA

Engage natural supports and community resources to assist in overcoming barriers to engagement or access to care

Engage and collaborate with all integrated care team members and conduct team meetings as necessary to make sure client's medical and mental health needs are understood by all team members

Understand and maintain HIPAA and 42CFR Part 2 confidentiality standards

Participate in all mental health department training and supervision

Be proficient in all aspects of the CareLink Policy Manual and additional program-related requirements

Perform other duties as assigned

QUALIFICATIONS Minimum

Hold a bachelor's degree in a relevant field from an accredited university and/or two years of relevant behavioral healthcare experience; or

Hold Licensure as Behavioral Health practitioner (e.g. Social Worker, Counselor, Marriage and Family Therapist); or

Registered Nurse

Must pass required background checks and drug screenings

Commitment to the highest ethical standards of the profession

Maintains confidentiality and discretion as a rule

Meets specified deadlines and manages time effectively

Exhibits skills in comprehending, interpreting and completing delegated tasks efficiently, and ask questions when something is not understood

Self-starter; must have the ability to work independently and follow-up on all work assignments given by the CareLink Supervisor or the Director of Community Services

Ability to multi-task, prioritize and work under pressure without losing sight of objectives

Exemplary organizational skills

Must be computer literate to effectively maintain compliance with all standards and requirements

Professional communication skills (e.g. responds to all emails and correspondence (voice messages, telephone encounters and messages)) in a timely manner (24 hours or less)

Keep CareLink Supervisor or the Director of Community Services informed of CLNM member's changes in both physical and mental health status, urgent issues, and questions about confidentiality

Maintains a valid and unrestricted NM Driver's License

Must be able to use personal vehicle over course of employment

Maintains valid and sufficient personal automobile insurance

Preferred

Previous work providing in-home or community-based mental health or case management services

Experience with medically integrated mental health services

Demonstrated interest in rural and community health

Fluency in English and Spanish, both verbal and written

CONDITIONS OF WORK Hiring and promotion will be accomplished in compliance with the GCLC's Personnel Policies and Procedures. This position is exempt under the Fair Labor Standards Act. This position requires a minimum of 40 hours per week, generally Monday through Friday. Hours or days may vary according to need. Personal transportation is mandatory. Travel may be required for delivery of services, training, or conferences.