What are the responsibilities and job description for the Case Manager ( Pathway Home ) position at Postgraduate Center for Mental Health?
JOB SCOPE: Experienced Case Manager to work on a NY State Office of Mental Health (OMH) funded Adult Home Care Transition team that exclusively serves class members transitioning to the community from an Adult Home. The role will involve addressing the preparatory needs of participants in the early stages of discharge planning, development of daily living skills, and coping mechanisms through group and individual work at the Adult Home. The team will follow class members into the community using the Pathway Home model of care to ensure that they become both linked and engaged with identified community providers and that their support network is sufficient to meet their needs. The role will require on call coverage and a willingness to work flexible hours.
ESSENTIAL FUNCTIONS:
Responsibilities include but are not limited to the following:
EDUCATION AND EXPERIENCE:
Minimum of a Bachelor's Degree in a Human Service discipline required
Minimum 2 years of case management work experience in a social service agency is required, preferably providing direct services to persons with Serious Mental Illness, developmental disabilities, and/ or substance use disorders.
ESSENTIAL FUNCTIONS:
Responsibilities include but are not limited to the following:
- Engagement beginning in the Adult Home, involvement in transition planning, and a needs assessment of transition supports essential to community integration and stabilization;
- Individual or group support sessions with emphasis on prevention and preparing for independent community living and the promotion of optimum mental and emotional health; may require helping individuals deal with issues associated with addictions and substance use, family and social relationships, stress and symptom management, activities of daily living, medication management, and housing readiness;
- Work with Class Member and their Disciplinary Care Team to resolve clinical issues that are impacting on the members ability to obtain, manage, and retain supportive housing;
- Foster relationship and advocacy with community provides to ensure that members are connected with appropriate services as they transition back into the community and to expedite and solidify placement in community housing;
- Community navigation including accompanying to first behavioral health and medical appointment, travel training, reengagement in community care, referral to services with ability to identify and address potential services and barriers to obtain and maintain such services;
- Establish collaborative working relationships with Adult Home Administrative staff, Housing Contractor, the Peer Specialist and other partners and plan with them for appropriate community transition;
- Provide intensive emotional and practical support to Adult Home Class member as they transition back into their communities;
- Act as a liaison and collaborates with Department of Health, Managed Care Plans, and Housing Contractors.
- Prepares AH Plus Reports, including the identification of trends, CBC AH Plus Capacity Determinations, Post Community Transition Assessment, Discharge Planning Tools and tracking of incident reporting.
- Provide out of hours crisis intervention services to recipients and their support network, including respite referrals and other diversion and stabilization services;
- Attend and participate in team meetings and supervisory sessions;
- Develop short term person centered treatment plans to assist recipient towards achieving their goals;
- Monitor and record recipient’s progress with respect to treatment and community integration goals;
- Assist and instruct individuals in attending to personal hygiene, grooming and laundry, nutrition and meal preparation, budgeting, and other daily living and socialization tasks and skills needed to live, work, and socialize successfully in the community environments of their choice while maintaining a safe living environment;
- Comply with all required in-service training and staff development;
- Perform other related duties as assigned;
EDUCATION AND EXPERIENCE:
Minimum of a Bachelor's Degree in a Human Service discipline required
Minimum 2 years of case management work experience in a social service agency is required, preferably providing direct services to persons with Serious Mental Illness, developmental disabilities, and/ or substance use disorders.