This position supports the transition of services through the system of care by partnering with individuals receiving care and their identified care team members. Advocates, facilitates, manages, and coordinates linkage of care and post-discharge services to external service providers, support agencies, and other organizations. Actively monitors and engages individuals receiving care, documenting and tracking activities of daily living, interpersonal functioning, and progress toward individual treatment goals.
Essential Functions
Supports the delivery of care and engagement of individuals under care by participating in group supervision and by reviewing evaluations, assessments, treatment plans, and progress notes. to understand the unique needs, strengths, preferences, and goals.
Assesses the needs of the individual receiving care across multiple domains including mental health, medical, social, and other services by completing needs assessment and other appropriate tools.
Partners with the client receiving care and their care team to identify clinical goals, interventions, and strategies, documenting in the discharge plan.
Initiates and submits referrals to medical and behavioral health care, community programs, and service providers.
Develops and maintains strong working knowledge of care partners, service providers, and stakeholders across the system of care, maintaining a positive rapport.
As approved and assigned, uses company vehicles to provide transportation for individuals entering, receiving, or discharged from care.
Collaborates with care team members for admission and discharge from the residential milieu, engaging external stakeholders when appropriate and as directed during these transitions.
Serves as a liaison as assigned and appropriate for internal and external stakeholders, care partners, and visitors.
Demonstrates adherence to company policies, expectations, and behavioral competencies, both explicit and implicit.
All tasks, projects, and/or duties as assigned and authorized, as determined by Human Resources and Direct Supervisor (or designated delegate) to be congruent with the role.
Qualifications
Education:
Bachelor's Degree in Human Services or a related field is required.
Experience
Two years of work or engagement experience working with individuals living with dynamic and complex behavioral health needs is required
Additional
One year community health experience, Required
Valid and unrestricted driver’s license, Required
Proficiency with Microsoft Office Suite Products, Required
Credentials
Proficiency and familiarity with EHR/EMR systems, Preferred
Physical Demands
Mental Health First Aid Certification, Preferred
Prolonged periods of sitting at a desk or computer workstation.
Prolonged periods of standing, bending, and reaching.
Must be able to lift weights up to 50 pounds at times.
Psycho-Social Demands
Seeks guidance/help proactively to support safety and quality care.
Demonstrates skill of distress tolerance to maintain calm and safety.
Models positive regard with all members of the community of care.
Establishes and maintains interpersonal boundaries.
Maintains personal and situational awareness through self-reflection.
Practices ethical, evidence-based, and person-first decision-making.
Seniority level
Mid-Senior level
Employment type
Full-time
Job function
Other
Industries
Mental Health Care
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