Social Worker Case Manager - Supervised Housi

JOB TITLE: Social Worker/Case Manager – Supervised Housing Program (Full-time)

EMPLOYER: Pathways, INC

DEPARTMENT: Clinical Programs

REPORTS T0: Clinical Director and/or Designee

FLSA Status:Exempt

The Social Worker/Case Manager provides recovery-oriented case management and rehabilitative services to adults (18+) with serious and persistent mental illness and/or co-occurring psychiatric and substance use disorders, including individuals who are medically indigent. Services are delivered within a 24/7 supervised housing environment and in community settings in accordance with Connecticut Department of Mental Health & Addiction Services (DMHAS) contractual requirements, Local Mental Health Authority (LMHA) coordination, and Pathways, Inc.

policies. The Case Manager supports individuals to develop skills for successful community living, increased independence, and sustained recovery.

• Conduct comprehensive, person-centered assessments (strengths, needs, skill deficits, recovery goals, supports).
• Formulate individualized rehabilitation/recovery plans with measurable goals, objectives, interventions, responsible parties, and timelines in collaboration with the client, supervisor, and community support team.
• Prepare and complete quarterly assessments/treatment plan updates covering residential functioning; psychiatric/mental status; social/vocational domains; financial/money management; use of community resources; and progress toward goals.
• Review and update rehabilitation plans on an ongoing basis and formally every 90 days to determine continued appropriateness of placement and services.

• Provide case management and rehabilitative services consistent with DMHAS Supervised Housing requirements and Pathways procedures.
• Teach, coach, and assist with IADL and daily living skills, including:
• Personal hygiene and grooming
• Meal planning and preparation
• Shopping and budgeting/money management
• Medication adherence and monitoring
• Use of public transportation/travel training
• Time management and use of leisure time
• Interpersonal and communication skills
• Housekeeping and maintaining safe living environments
• Deliver supportive counseling focused on community living, interpersonal relationships, and recovery goals.
• Assist in developing coping strategies, relapse prevention, self-management skills, and problem-solving abilities.
• Provide or arrange individual and group services, and referrals as clinically indicated.

• Facilitate access to community resources, recovery supports, self-help groups, advocacy organizations, mentors, and entitlements/benefits (federal, state, and local).
• Coordinate referrals to medical, behavioral health, substance use, vocational, educational, and other services.
• Assist clients in obtaining and maintaining competitive employment or enrolling in educational/vocational programs.
• Support housing stability via housing resource coordination—assisting with finding, obtaining, and sustaining safe, affordable housing as needed.
• Promote community integration through involvement in faith-based, recreational, civic, and social activities.

• Provide crisis intervention/support following agency protocols and DMHAS guidelines; complete timely incident reports per agency and state requirements.
• Coordinate with emergency services, LMHAs, and other providers during crisis episodes to ensure continuity and safety.

• With client consent and when clinically appropriate, involve family members, significant others, and authorized advocates in recovery planning and service delivery.
• Provide education, consultation, and support to families regarding recovery and community living.

• Maintain timely, accurate, and complete documentation in the Electronic Health Record (EHR), including progress notes, treatment/rehabilitation plans, quarterly reviews, discharge summaries, and other required records within defined time frames.
• Maintain proper documentation of medication changes for residential clients and communicate changes to residential staff. For the MRO/Davis program (or as applicable), record medication refills and prescriptions in the client chart.
• Complete state-required documents in accordance with deadlines, e.g., DMHAS reporting, Mental Health Waiver, Time Studies, and (as applicable) DDAP and related state forms.
• Complete CARF-required tasks (e.g., quarterly chart reviews for another program, monthly CARF trainings, and required CARF forms).
• Conduct quarterly record reviews and annual face sheet reviews with ongoing updates.
• Enter required data into DMHAS information systems by established deadlines.
• Support program compliance with utilization requirements, performance outcomes, audits, site visits, and quality assurance standards.
• Maintain effective working relationships with LMHAs, DMHAS, and community providers.
• Participate in case conferences,…