Health Home Plus Care Manager #1718

Essential Job Functions

• Maintain engagement with individuals who are often disengaged from care, have difficulty adhering to treatment recommendation, or have a history of homelessness, criminal justice involvement, first episode psychosis, and transitional-aged youth
• Effectively support individuals through skills and practices including but not limited to motivational interviewing suicide prevention, risk screening, trauma-informed care and person-centered planning.
• Hold a caseload of up to 20 individuals who meet HH+ eligibility for high need services
• Ensure documentation is accurate and completed on time
• Responsible for, but not limited to comprehensive assessment, outreach and engagement, service and treatment linkages and coordination using evidence-based practices and outcomes
• 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)
• Demonstrate proficiency at navigating the health care system, including ability to make referrals to housing services, crisis intervention, peer support.
• Support consumers using trauma informed practices with linkages to identified resources, coordination of care among providers, advocacy, and support with identified recovery goals.
• Develop and revise individual plans of care consistent with Health Home requirements and coordinating with the Managed Care organizations for HARP members.
• Develop and maintain professional relationships through open communication and strong collaboration with community services
• Personally assist consumers with identifying and achieving person centered goals and recovery
• Monitor consumer wellness and ensure well-coordinated care among all providers
• Develop and maintain appropriate and accurate records and files according to all county and organization policies and procedures as well as all governing and regulatory standards
• Attend necessary meetings
• Maintain regular and effective communications with supervisor, county service providers, and all relevant parties as needed
• Collaborate with hospital or treatment providing staff as well as Managed Care Organizations for successful transitions of care
• Address the quality, adequacy, and continuity of services to ensure appropriate support for individuals mental health and psychosocial health needs
• Meet weekly to bi-weekly for supervision, participate in monthly clinical supervision, case conferences, and other relevant meetings and trainings
• Participate in On-call rotation
• Adhere to Medicaid, Office of Mental Health and Health Homes billing standards
• Secure all health records and other protected information with the highest regard to confidentiality and
• HIPPA laws and regulations
• Provide each member of the caseload with a minimum of four health home core services per month, including but not limited to face to face, at home visits and telephonic contact
• Engage families, natural supports, and providers into the care coordination process

Health Home + / HARP Qualifications

1. A Master’s degree in one of the qualifying1 fields and one (1) year of Experience; OR

2. A Bachelor’s degree in one of the qualifying fields and two (2) years of Experience; OR

3. A Credentialed Alcoholism and Substance Abuse Counselor (CASAC) and two (2) years of Experience; OR

4. A Bachelor’s degree or higher in ANY field with either

three (3) years of Experience, or two (2) years of experience as a Health Home care manager serving the SMI or SED population

5. Staff who meet the Waiver qualifications as outlined by the state.

6. NYS Driver’s License (as driving is an essential function of this position)

**Qualifying fields include education degrees featuring a major or concentration in: social work, psychology, nursing, rehabilitation, education, occupational therapy, physical therapy, recreation or recreation therapy, counseling, community mental health, child and family studies, sociology, speech and hearing or other human services field.

**Experience must consist of

1. Providing direct services to people with Serious Mental Illness, developmental disabilities, alcoholism or substance abuse, and/or children with SED; OR

2. Linking individuals with Serious Mental Illness, children with SED, developmental disabilities, and/or alcoholism or substance abuse to a broad range of services essential to successful living in a community setting (e.g. medical, psychiatric, social, educational, legal, housing and financial services).

Knowledge

Thorough knowledge of community services within service area; general knowledge and understanding of Mental Illnesses, Psychiatric Rehabilitation model and related issues. Has a basic understanding of the importance of working from a trauma sensitive perspective. General knowledge of chronic health issues and the impact they have on overall well-being. Understanding of and ability to utilize motivational interviewing.

Skills and Abilities

Must encompass and be able to incorporate key skills to practice and engage high-need SMI individuals which can include; motivational interviewing, suicide prevention, risk screening, trauma informed care, person centered care planning and interventions, and recovery oriented approaches; Proficient in the ability to improve quality of life and outcomes for high-need individuals with SMI; Use of contemporary office equipment particularly a computer with word processing, database and report generating software; to communicate effectively with diverse individuals and to record notes as needed; to listen, understand and appreciate the experiences of clients; to establish rapport and meaningful professional relationships; to manage and resolve conflicts; to provide positive role-modeling; to inspire respect, confidence and trust in consumers and co-workers; to respect and maintain appropriate confidentialities; to effectively encourage clients toward greater independence and self-sufficiency; to perceive and describe changes in behavior; to generate and maintain accurate records and reports as required; to seek, accept, and learn from supervisor and peer feedback; to organize time effectively; to plan and implement strategies consistent with consumer needs and overall organization goals, objectives, and standards; to meet deadlines regularly; effectively manage change.

Physical Requirements and Working Conditions

Substantial amount of driving involved. General office environment

Any external candidate interested in this employment opportunity, please visit our web site at www.lakeviewhs.org [http://www.lakeviewhs.org].

Lakeview Health Services, Inc. complies with the legal requirement to take affirmative action and not discriminate on the basis of race, color, sex, sexual orientation, gender identity, religion, national origin, disability, or status as a protected veteran. Further, Lakeview Health Services, Inc. will not discharge or otherwise discriminate against applicants or employees who inquire about, discuss, or disclose their compensation or that of others, subject to certain limitations.