Care Coordinator

Job Description

Job Description

Summary / Objective :

Primary job responsibilities involve assessing needs, service and resource linkage, and care coordination to support youth and families / caregivers in the OhioRISE plan in achieving their health and outcomes goals. Care Coordinators are primarily community-based and may be able to perform some tasks from home. Care Coordinator Non-Licensed will work with individuals, parents / guardians, Boundless staff, community members, and other service and support providers via face-to-face engagement, telephone, video conferencing, and electronic communication. Day-to-day activities are varied based on the needs of the individuals and families / caregivers on the caseload. The Care Coordinator Non-Licensed serves as a primary point of contact and liaison for all the vital support providers in a youth or family's life, including scheduling meetings, tracking, exchanging documentation, following up on needs and appointments, and reporting outcomes.

Essential Functions :

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Participate in ongoing assessment of needs of individuals and family / caregivers utilizing assessment and screening tools, including completion of and updating of the Ohio Brief or Comprehensive CANS assessments, as required.
• Complete initial and ongoing outreach and contacts with individuals and family / caregivers within required timelines.
• Convene and facilitate child and family team meetings according to required timelines.
• Develop, review, and update child and family-centered care plans according to required timelines.
• Monitor child and family-centered care plans to ensure that services are delivered in accordance with the plans.
• Participate in developing, reviewing, and updating crisis safety plans according to required timelines with a licensed professional collaborator.
• Perform referrals and linkages to appropriate services and supports, including natural supports, along the continuum of care.
• Facilitate discharge planning activities for youth admitted to a psychiatric residential treatment facility or an inpatient behavioral health facility.
• Facilitate transition activities for youth transitioning between facility and community-based settings.
• Submit child and family-centered care plans to the OhioRISE plan according to required timelines.
• For youth and children enrolled in the OhioRISE plan, facilitate the transition, as appropriate, out of the OhioRISE program.
• Provide on-call availability and support for youth and families / caregivers outside regular business hours, as needed.
• Identify formal and informal resources in the communities served, initially and on an ongoing basis, paying particular attention to the availability of culturally responsive resources. Link individuals and families served to the resources as needed and update databases to share resource information.
• Track and report when less than two providers of a needed service are available within a community to offer an individual or family. Participate in team and community meetings regarding necessary resource development specific to the communities served.
• Facilitate the completion of necessary forms and documentation, including consent for release information with relevant stakeholders and child and family teams.
• Establish and maintain positive relationships with the local system of care partners such as the children's services system, Title IV-E agencies, boards of developmental disabilities, local corrections and court systems, schools, family and children first councils, managed care organizations, providers of behavioral health services, and primary care providers.
• Support individuals and families in accessing medically necessary services and supports.
• Serve as a liaison between individuals, families, and care team members to positively promote collaboration.
• Complete all documentation as required, including gathering and reporting of all health and outcomes data.
• Manage phone calls and communication from individuals, families, guardians, and stakeholders, etc. Coordinate meetings and ensure information is exchanged consistently.
• Respond to and be available for clients and families in crisis, as needed, including referencing the crisis plans and facilitating the appropriate linkage to de-escalate the crisis.
• Meet engagement, documentation, and contract requirements as established by management.
• Provide excellent customer service and communication coordination between team members, individuals, families / caregivers, community members, and collaborating organizations.
• All other assigned duties.

Skills, Knowledge, & Abilities :

Supervisory Responsibility :

This position does not request any supervision of staff.

Work Environment :

This job regularly works in the community, providing services outside of the office, in schools, client homes, and other community settings. This role routinely uses standard office equipment such as computers, phones, and photocopiers.

Physical Demands :

The physical demands described here are representative of those that an employee must meet to perform the essential functions of this job successfully. While performing the duties of this job, the employee is regularly required to talk or hear. The employee frequently is required to stand, walk, and reach with hands and arms.

Position Type / Expected Hours of Work :

This is a full-time position, and hours of work and days are Monday through Friday, during business hours. Evening and weekend work may be required as job duties demand based on needing to link an individual or family in crisis to the appropriate resources or perform initial outreach to a crisis referral.

Travel :

Travel is primarily local during the business day, although some out-of-the-area and overnight travel may be expected occasionally. Position may require transporting clients as appropriate to support their linkage needs.

Education / Experience :

Family systems

Additional Eligibility Qualifications :

Other Duties :

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties, or responsibilities required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.