Complex Care Manager

GENERAL SUMMARY

Provides direct services for consumers and completes associated case management documentation for the consumer and program. Works within a multidisciplinary team to provide an array of direct (face‑to‑face) and indirect clinical services to adults in a person‑centered, trauma‑informed, individualized focused approach utilizing evidence‑based practices delivered to fidelity. These services are delivered in multiple types of settings including field‑based services in the individual’s home or other identified locations as well as clinic‑based services.

Individuals served may have multi‑system involvement such as Criminal Justice, Child and Adult Welfare, Veterans, Homelessness, etc.

• Assists with developing new/temporary programs that arise in response to catalyst incidents such as community needs, natural disasters, etc.
• Completes indirect support activities, including documentation, correspondence, death review packets, and prescription assistance program consultations.
• Conducts assessments and develops treatment plans for consumers, including monitors/reports consumer progress with treatment goals. This may include reporting to the legal system and other community partners.
• Coordinates intake function to Adult Behavioral Health in designated programs.
• Documents all clinical interactions and updates in electronic medical records and other required platforms.
• Ensures clinical documentation is submitted in accordance with CHCS standards and contract‑specific requirements and complies with Quality Improvement Processes.
• Participates in professional development duties, including special assignments/projects such as Operational Process Improvement Work Groups/Committees, Agency Wide Committees, and Community Meetings.
• Participates in supervision and development opportunities, including individual/group supervision and meetings/training as assigned.
• Diverts consumers from jail, emergency rooms, and hospitals to help reduce recidivism and decompress emergency rooms.
• Provides case management support and various activities, including care coordination, direct services, discharge planning, referrals, linkage and transition to the next level of care, emergency case management assistance as needed, psychosocial rehabilitation services (individual or group), recovery planning, resource development and cross‑collaboration with interdisciplinary teams.
• Provides skills training and psychosocial rehabilitation services that address the severe and persistent mental illness and symptom‑related problems that interfere with the individual’s functioning.
• Participates in coordination and communication with law enforcement, hospital personnel, and other community providers on the progress of individuals receiving and collaborating services.
• Provides crisis intervention to individuals to reduce symptoms and prevent admission to a more restrictive environment.
• Provides services in vivo, meeting the consumer where they are in the community.
• Provides unit, operations, agency, and community training and education as assigned.
• Supports CHCS No Show Efforts by utilizing appropriate scheduling and communication tools.
• Employees on the Complex Care team will perform duties such as an after‑hours on‑call rotation, including weekends and holidays.
• Trains, mentors, and coaches new employees.
• Performs other related duties as required.

Complex Care, Crisis and Justice Programs at The Center for Health Care services are unique subdivisions under the umbrella of Adult Behavioral Health services. Clinicians in these programs serve as the subject matter expert in triage, assessment, de‑escalation, and care navigation as these team members are provided with the tools/skills necessary to advocate, assist, and motivate consumers to take part in their recovery.

Complex Care focuses on tailoring services to individuals that would benefit from a multidisciplinary, team‑based approach. Our teams (AOT, ACT, FACT, and POWER) strive to build community connections and tackle stigma associated with severe mental illness. As a result, our teams work closely with…