CTI Care Coordinator

Job Definition

The Care Coordinator works with the CN Guidance Critical Time Intervention Team to deliver services within an evidence-based model that is time limited, phase-based care management approach focused on enhancing continuity of care during transitional times. Care Coordinators develop person-centered plans, share knowledge of community resources, provide linkage to resources, and engage individuals in skill building.

Bachelor's Degree or Master's Degree in one of the following fields preferred:
Social Work, Psychology, Education, Rehabilitation, Occupational Therapy, Counseling, Community Mental Health, Sociology, Speech and Hearing, Physical or Recreational therapy. Degrees in other related areas may be considered.

• For H.S. Diploma/GED level candidates, four (4) years of related human service and direct service experience required.
• For B.A. level candidates, one (1) year of related human service and direct service experience required.
  • Experience should be in providing direct services to individuals with severe mental health disorders, co-occurring substance abuse disorders, developmental disorders, and/or physical disabilities, in linking clients to a broad range of services essential to independent community living, and in advocacy for underserved or disenfranchised populations.
• Bilingual preferred.
• Working knowledge of computer software and electronic health record systems.
• Demonstrated competency in written, verbal and computational skills to present and document records in accordance with program standards.
• Experienced in and demonstrated comprehensive understanding and working knowledge of the interdisciplinary planning process and the developmental treatment model.
• Knowledge and sociological understanding of Medicaid, Social Security and other entitlements preferred.
• Excellent interpersonal skills required.
• Knowledge of cultural competence and sensitivity.

• Conduct initial and ongoing assessments of assigned clients to document strengths, needs, goals and resources.
• Participate in the development, documentation, review and update of client-centered comprehensive, integrated, interdisciplinary care plans in consultation with Program Supervisor and other team members to ensure focus on desired outcomes.
• Maintain effective communications with clients, primary care physicians, substance abuse and mental healthcare providers, family, collateral resources and other Agency staff on behalf of clients.
• Maintain documents, records, statistics, and other related reports in an organized, timely and accurate manner as per policy and procedure.
• Coordinate care planning with other providers of services/resources to ensure goal directed, collaborative care, including care transitions.
• Work as part of the CTI team and attend and participate in team meetings to provide input/feedback around psychosocial conditions/comorbidities to review client status, update plans and goals, review outcomes to further program goals.
• Act as a resource/consultant to all team members on psychosocial and/or substance abuse issues and resources.
• Provide face-to-face as well as telephonic outreach, engagement and service planning in the field.
• Act as a linkage to community services including medical, behavioral, residential, entitlement and any other needed services per interdisciplinary care plan.
• Monitor overall service delivery to clients to ensure coordination and continuity; advocate with service providers/resources as needed.
• Provide crisis intervention and follow-up on an as-needed basis 24 hours a day, 7 days a week.
• Actively engage in agency wide trainings and work groups as well as NYS specific training on and for the CTI model.
• Participate in ongoing supervision, training and education as needed to ensure a high quality of service delivery and continued professional growth.
• Facilitate sharing of data with the individuals to whom it applies to facilitate partnered decision-making and to keep clients informed of progress.
• Complete QI training during onboarding and participate in QI refresher training as needed.
• Ability to cultivate a culture of inclusion for all employees that respects their individual strengths, views and experiences. A culture that makes better decisions, drives innovation, and delivers better business results.
• Adherence to all safety protocols and procedures to ensure a safe working environment for all employees. Demonstrate a commitment to maintaining a safe work environment by following established safety guidelines.
• Health and safety awareness:
  Include any relevant knowledge or experience regarding health and safety protocols to ensure a safe work environment for all employees.
• Other duties as assigned.

We offer an attractive and competitive benefits package for full-time employees which includes but is not limited to:

• Medical
• Dental
• Vision
• $0 Deductible Platinum Plus Medical Insurance Plan - 90% Employer Provided Benefit
• Flexible Spending Account
• 403(b)…