Summary: The Care Coordinator is responsible for conducting client assessments, completing required screening tools, coordinating follow-up care, and ensuring individuals are connected to appropriate behavioral health, medical, and community-based services. This role serves as a key access and engagement point for clients, supporting stabilization, continuity of care, and ongoing service engagement. Care Coordinators work closely with clinical teams, providers, and utilization management to assess needs, reduce barriers to care, and ensure services are delivered in compliance with DBH and Medicaid requirements. This position is Hybrid and will require in office days as scheduled by your manager.
Role: Lead, Manage, Accountability (LMA) Primary Job Responsibilities: - Assessments & Screening
- Conduct initial assessments to identify client needs, risks, strengths, and service priorities
- Complete and document required screening tools and standardized assessments in accordance with DC DBH and program requirements
- Complete follow-up assessments and screenings to monitor engagement, progress, and changes in clinical or social needs
- Ensure assessments and screenings are accurate, timely, and meet documentation standards
- Care Coordination & Follow-Up
- Coordinate behavioral health, medical, and social services based on assessment findings
- Schedule and follow up on referrals for therapy, psychiatry, primary care, and supportive services
- Conduct outreach to address missed appointments, disengagement, or service gaps
- Support transitions of care following hospitalizations, emergency department visits, or changes in level of care
- Documentation & Compliance
- Complete all assessments, screenings, authorization-related documentation, and service notes in the EHR in compliance with DC DBH and Medicaid standards
- Ensure documentation supports medical necessity, service authorization, and audit readiness
- Maintain compliance with HIPAA, confidentiality, and organizational policies
- 120 Billable hours per Month
- Client Engagement & Outcomes
- Build and maintain professional, trust-based relationships with clients and families
- Support clients in identifying goals related to stability, wellness, and recovery
- Monitor client progress and identify early indicators of disengagement or increased risk
- Participate in multidisciplinary team meetings and care planning
- Community & Provider Collaboration
- Communicate assessment outcomes and care coordination needs with internal clinical teams
- Collaborate with external providers, hospitals, shelters, and community organizations to ensure continuity of care
- Maintain 80% weekly productivity
Qualifications: - Bachelors or Master’s degree in Healthcare Administration, Business, or related field
- Active DC Professional License in Social Work or Counseling (LICSW, LGSW, LPC, LGPC, LMFT, RN)
- LG licensed professionals must receive supervision from an outside agency.
- Minimum 3 years of leadership experience in mental health operations.
- Deep knowledge of Medicaid, managed care, and behavioral health regulations.
- Ability to manage multi-site, multi-state programs with a focus on compliance, financial sustainability, and outcomes.
- Strong financial and operational management skills with budget oversight experience.
- Excellent interpersonal, communication, and leadership skills with the ability to lead people.
- Strong leadership, communication, and problem-solving skills.
- Proficiency in EHR systems (Credible preferred), Microsoft Office Suite, and data reporting tools.
Competencies: - Do the Right Thing – Doing what’s right starts with integrity. It means being honest about your actions, your intentions, and how you treat people—especially when no one’s watching.
- Own It – Everyone has a part. If you’ve been trusted with something, it’s because it’s yours to manage. When we all take care of our piece, everything runs like it should.
- Serve First – Follows policies and procedures; Completes administrative tasks correctly and on time; Supports organization's goals and values; Benefits organization through outside activities; Supports affirmative action and respects diversity.
- Choose Solutions – You always have a choice. Our strength is in choosing what moves us forward. Be someone who solves, and choose what helps, not what hurts.
- Lead with Respect – You can’t lead others if you don’t respect yourself first. Respect shows up in how we speak, how we act, and how we care for people. Leadership starts inside.
- Commit to the Goal – The plan might shift. The process might change. People might come and go. But the goal stays the goal. Get there—and make sure we’re getting there together.
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