TBI Service Coordinator

PRIMARY FUNCTIONS:

Provide service coordination to individuals within the Traumatic Brain Injury (TBI) Waiver and Nursing Home Transition and Diversion (NHTD) Waiver programs living in Monroe, Finger Lakes or Southern Tier Regional Counties.

SPECIFIC DUTIES:

1. When needed, serve as contact for referrals, gathering required documentation, and arrange for necessary screenings to proceed with intake in applicable program.
2. Provide participant-guided service coordination to caseload assigned, maintaining accurate and verifiable documentation of all services rendered.
3. Using a person-centered approach, develop and complete comprehensive service plans, PPOs, and all other required documentation as set by DOH and Regional Resource Development Center.
4. Demonstrate, promote and practice cultural competency towards participants through respect and understanding.
5. Recognize and embrace diversity through supporting and encouraging the strengths of each individual served.
6. Provide a minimum of 1 face to face contact meeting for each participant assigned monthly (meeting must occur in the participants home on a quarterly basis), to ensure all service plan goals are addressed to the satisfaction of the participants served and to monitor overall provider plans effectiveness.
7. Utilizing a team approach, maintain accessibility for clients during the workday.
8. Assist participants in the acquisition and maintenance of public benefits e.g., Medicaid, SNAP, Social Security, etc.
9. Provide linkage/referrals and coordination of resources/support for medical care, mental health, social, recreational and housing/basic needs, etc.
10. Remain current in the field, support and implement best practice service models within the program.
11. Make independent decisions and recommendations regarding immediate risk factors presented and provide crisis intervention and follow-up as needed.
12. Demonstrate flexibility to be available to clients in their homes/communities including working outside of normal business hours as needed.
13. Provide on-call availability via cell phone to the TBI and/or NHTD program as needed.
14. Serve as a participant advocate.
15. Ensure the assessment of need for a nursing home facility level of care on an annual basis.
16. Facilitate the development of a Care Team to carry out individualized and strength-based Service and Detailed Plans through regular team meetings and plan reviews.
17. Participate in staff meetings and other Care Coordination department activities.
18. Ensure compliance with all applicable local, State and Federal regulations and agency policies.
19. Participate in all mandatory ongoing training and professional development offered.
20. Represent Catholic Charities Community Services on appropriate boards and committees as assigned by CC Director.
21. Other duties as assigned.

Qualifications

Education: Bachelors degree in Human Services or related field.

Experience: Three years paid experience providing service coordination to individuals with disabilities.

Bilingual (English/Spanish) is required for some positions. If position required Bilingual skills to be used, additional compensation will be offered.

A combination of education and experience may be substituted at the discretion of the funder.