Reporting to the BHH Administrative Leader and Clinical Lead, the Care Coordinator is responsible for providing a full range of care coordination services and health promotion for clients enrolled in the Behavioral Health Home (BHH). The care coordinator is responsible for drafting the plan of care, coordinating services and encouraging BHH members to actively participate in addressing goals identified in the plan of care. The care coordinator is part of the Behavioral Health Home team, and will contribute to a team-based approach to care.
The Care Coordinator will ensure the Behavioral Health Home program provides enhanced access to care, promotes consumer/family directed care planning, addresses behavioral-physical health integration and provides connection to community resources/social support services.

ESSENTIAL FUNCTIONS:

• This is a direct service and care coordination position, which requires an average of 25 hours per week of direct service contact, which includes face to face, by phone or collateral care coordination contact. All direct service and care coordination contact requires documentation of such in the EHR.
• Provide comprehensive care coordination services to ensure clients receive timely and coordinated services that address physical and behavioral health needs and promote community and home-based recovery.
• Responsible the overall management of the plan of care (with involvement of the client), including drafting the plan of care, completing quarterly reviews and summarizing progress toward goals.
• Support clients in addressing plan of care goals and objectives, with a focus on self advocacy.
• Obtain necessary consent and releases for BHH care coordination and information sharing.
• Ensure BHH clients are connected to a Health Home Practice for primary care services.
• Assist in the development and implementation of crisis plans.
• Maintain accurate and compliant documentation of all direct and indirect client activity.
• Review and enter Peer Supports Specialist documentation into the electronic health record.
• Provide health promotion education, information, outreach and training to clients for developing self-monitoring and health promotion management skills.
• Promote healthy lifestyle and wellness strategies, which includes: substance use prevention, smoking cessation, nutritional counseling, weight management and increasing physical activity.
• Coordinate and support access to services and self help groups that support preventive health and chronic disease management.
• Provide comprehensive transitional care support, to ensure continuity of care and prevention of unnecessary use of emergency rooms and hospitals.
• Actively engage in regular clinical and administrative supervision, and participate in annual appraisal of performance.
• Participates in BHH Team meetings and staff trainings as required.
• Performs other duties related to the position that may be assigned from time to time.
• Scan for gaps in client care and complete referrals for needed services and supports; actively involving clients in referral plans.

GENERAL EXPECTATIONS:

• Be committed to the mission, vision, and values of the organization.
• Work collaboratively as a member of a team with various groups of staff, depending on the issue addressed.
• Assure quality in work performed to facilitate the delivery of quality services.
• Reports accidents and injuries in a timely fashion, demonstrates safe housekeeping practices, notifies supervisor of potential health and safety concerns immediately, participates in health and safety training as required, understands and follows all OCMHS and safety policies.
• Some transportation of clients in personal vehicle is required, so you must carry adequate vehicle insurance.
• Respects clients’ dignity and preferences in all interactions.
• Maintains cooperative, collegial relationships that support mutual understanding and problem solving with other programs and departments, recognizing their mission and roles, and responding to their requests in a timely manner within the resource capabilities of the program and staff.
• Communicates with all colleagues and peers in a respectful, professional, responsive manner that promotes teamwork and supports positive outcomes for clients.
• Maintains up-to-date familiarity with clients, progress in treatment, barrriers, and direction in treatment
• Demonstrates at all times the commitment to providing the least intrusive service intervention that supports the clients’ needs in the least restrictive setting that supports client and staff safety.
• Represents the agency at community events and statewide provider meetings.
• Other duties as assigned.

EDUCATION, CERTIFICATES, LICENSES, REGISTRATIONS REQUIRED:

• Associates or a Bachelor’s Degree in Human Services or a related field and,
• MHRT-C Certification

Job Type: Full-time

Job Types: Full-time, Contract

Pay: Up to $22.00 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Disability insurance
• Employee assistance program
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift

Education:

• High school or equivalent (Preferred)

Ability to Relocate:

• Norway, ME: Relocate before starting work (Required)

Work Location: Multiple locations