Service Coordinator, Continuum of Care

Job Description

Job Description

The Service Coordinator, Continuum of Care reports to the Team Leader, Service Integration and is responsible for coordinating referrals and linkages to clinically indicated services supporting housing retention and eviction prevention within the Quality department for the Continuum of Care (COC) Program. The Service Coordinator’s role supports providers through an integrated approach to case management and community outreach while implementing program improvements that strengthen care management, member access, and health outcomes. This role additionally ensures quality of data reporting and project performance outcomes, including increasing income and non‐cash benefit measures.

ESSENTIAL DUTIES & RESPONSIBILITIES

• Supports the mental and physical health care of members on an assigned caseload.
• Closely coordinates care with member’s mental health, physical health, and / or substance use providers.
• Works closely with community resources and organizations to coordinate member services.
• Provides support and attempts to remove common obstacles and barriers to outpatient care.
• Facilitates member outreach, engagement, linkage, referrals, coordination, and follow up for mental health, physical health, and substance use services and supports.
• Identifies gaps in care for members and arranges appropriate and timely resolution with internal and external agencies.
• Identifies risk factors related to relapse and develops relapse prevention plans and strategies in conjunction with clinical consultation.
• Advocates for members who may be vulnerable or need additional support.
• Provides member education on common mental health, physical health, and substance use disorders.
• Provides brief interventions using evidence based psychosocial treatments, (CBT, MI) as clinically indicated.
• Participates in regularly scheduled caseload consultation. These consultations will primarily focus on members who are new to treatment, difficult to engage, or who are not improving as expected.
• Ensures grant compliance with program targets by identifying and linking participants who are in need of income, employment, or are eligible for benefits and assists in connection to employment services and coordinates mainstream benefits applications.
• Ensures compliance with service delivery, data quality, and program outcomes for permanent supportive housing programs.
• Collaborates closely with Thresholds Housing Administration, HMIS data administrator and Grants Accounting Team through the submission of partner service reports.
• Completes eligibility and needs assessment of referrals from the Coordinated Entry System (CES).
• Monitors service delivery of project service partners to program participants, including reviewing personnel activity reports.
• Conducts annual audits and files reviews for partner agency service providers.
• Provides accurate and timely information to their supervisor(s) on all topics and issues related to the project operations and wellbeing.
• Other duties as assigned.

MARGINAL DUTIES & RESPONSIBILITIES

EDUCATION

EXPERIENCE

SKILLS / CERTIFICATIONS

Subject to annual Department of Motor Vehicles license verification.

Must obtain and maintain $100,000 / $300,000 / $100,000 bodily injury and liability insurance. Subject to validation every six months.

What sets Thresholds apart :

Based on education, experience, and licensure

Thresholds is a mission-driven agency with a deep commitment to fostering an environment where all feel valued and respected, a place where every employee can be themselves, thrive, and support the agency’s mission. Click here to learn more.

One of the oldest and largest community mental health organizations in Illinois, we pride ourselves in being a Chicago Tribune Top Workplace and one of Chicago’s 101 Best & Brightest Companies to Work For, several years in a row.

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