Summary/objective
Ensure services for clients are coordinated internally and externally, referrals are managed seamlessly for clients, and a cohesive plan of services and support is clearly documented for each client on the assigned team. Support interdisciplinary teams to deliver exceptional services to clients and their families through internal and external coordination, documentation of team plans for coordination of care, follow-ups on necessary contacts and required documentation, and supporting transition between levels of care.
Pay Range/Benefit Package
Salary: starting at $41,184.00 up to $56,825.60 annually - placement above minimum salary is based on experience.
OnPoint Benefits:
Benefits effective date of hire:
Employer Paid benefits:
Essential functions
- Reasonable accommodations may be made to enable individuals with disabilities to perform these essential functions.
- Initiate, follow-up and document internal and external care coordination contacts and activities.
- Communicate effectively with individuals and entities involved in a consumer’s services and care, adapting communication as necessary.
- Establish working relationships with internal and external individuals and entities frequently involved in consumers’ services and care.
- Facilitate referrals and warm handoffs in partnership with consumers.
- Assure interdisciplinary team (IDT) members are updated on care coordination activities verbally and through EMR documentation.
- Request and follow-up on medical records from primary care, hospitals and specialty offices.
- Assure required release of information documents are completed and filed in the EMR according to established regulatory, funding, and agency best practice standards prior to any care coordination activities.
- Maintain updated contact information for all relevant individuals and entities in each consumer’s EMR.
- Actively participate in scheduled and impromptu IDT meetings and discussions to assure exceptional, coordinated, and effective care and service delivery.
- Coordinate contacts to ensure consistent messaging, non-duplication, and focus on overall treatment goals and objectives.
- Assure consumers are aware of care coordination activities and the intent of such activities, directly or via team members.
- Monitor responsiveness to internal and external care coordination activities as specified in CCBHC manual and CMHSP/PIHP contract and notify supervisor of trends.
- Coordinate with internal medical clinic to ensure proper PCP and other medical professional coordination
- Assist with scheduling appointments, including transportation for services, as assigned
- As part of a care coordination team, executes the following processes/tasks as assigned by supervisor:
- BTC process/paperwork
- NABD process (in connection with customer services) and submission or NABD’s across assigned teams
- Follow up with clients/coordinate with the clerical team on missed appointments and ensure rescheduling
- Support Children’s Outpatient, Home based or Wrap-Around Clients
- Support Adult Outpatient Clients
- Support Recovery Management Clients
- Support Adult Case Management Clients
- Support Medication Clinic Clients
- AOT Monitoring
- Regular contact with PCPs, providing care coordination according to OnPoint policies
- Provide back-up for primary care screenings and vital signs if trained to complete
- Assist clients as needed for walk in concerns related to care coordination
- Perform other duties as assigned.
Competencies:
- Ability to perform duties and document services in an electronic medical record according to regulatory, funding, best practice, and agency standards.
- Solid written and verbal communication skills
- Ability to work independently within a strong team environment.
- Ability to structure workload while accommodating unexpected situations and client and team needs.
- Maintain a focused and positive attitude to support clients, families, and teams.
Supervisory responsibilities:
None
Core Values:
- Integrity
- Inclusivity
- Honor
- Equality
- Humility
- Innovation
- Teamwork
- Cultural Competence
Environment (Work, Physical, Travel):
- Work Environment – Environments can vary. Primarily work in an office environment but travel by automobile to other locations within and outside of the County may be required.
- Physical Demands – Generally, performs sedentary work but must have the ability to lift up to 35 pounds. Occasional bending, stooping, kneeling, lifting. Ability to sit for extended periods of time.
Required education and experience:
- High school diploma/GED with at least two years’ experience in behavioral health service delivery with the target population, preferably in publicly funded setting
- Customer service experience
- Community Health Worker (CHW) certification through MDHHS or ability to complete training within the first six months of hire
Preferred education and experience:
- Associate’s degree in human services
- CCBHC experience
- Client-level systems coordination experience
- Working knowledge of mental health and/or substance use disorders and/or intellectual/ developmental disabilities.
- Lived experiences with mental illness/developmental disabilities/co-occurring disorders/substance use disorders.
Additional eligibility requirements:
Must possess a valid driver’s license, registration and proof of automobile insurance when operating County vehicles or operating personal vehicles in performance of job duties at any time. May provide own transportation for job related use, including transporting of individuals served, to and from meetings and activities at varying work locations throughout Allegan County.
Work authorization/security clearance requirements:
In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification form upon hire.
EEO statement
OnPoint is an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, national origin, disability status, genetic information, protected veteran status, sexual orientation, gender identity or expression, pregnancy, height, weight or marital status, or any other characteristic protected by federal, state or local laws.
