Job Details

Description

Responsible for coordinating services and supports for children/youth enrolled in the CSED Waiver program and their families. The facilitator works with the youth, family and care team (including formal and informal supports) and community resources to develop, implement and monitor individualized care plan in order to help the child remain in (or return to) their home/community environment and reduce use of out-of-home placements. This includes engaging in assessments, facilitating team meetings, linking to coordinating resources, monitoring progress and adapting plans as needed.

Essential Duties and Responsibilities include the following. Other duties may be assigned to meet business needs.

• Acts as Westbrook's primary contact with client.

• Coordinates and chairs the Interdisciplinary Team to ensure an Individual Treatment Plan is developed for each client and reviewed and revised as required.

• Provides person and family-centered care to clients.

• Advocates for and assists the client in obtaining needed physical, behavioral, and social services.

• Provides Targeted Case Management including supportive counseling services within scope of training and competencies for clients who are eligible for the services.

• Provides crisis assistance as needed including developing a personal crisis safety plan with client.

• Assure transportation needs are met for client including transporting clients to appointments as necessary.

• Provide care coordination services across different settings, including office, home and community.

• Records documentation of client services provided in electronic health record.

• Assists client in maintaining eligibility for applicable programs, monitoring financial status, and conducting required evaluations within timelines specific to applicable program regulations.

• Assists with Continuous Quality Assurance and participates in Utilization Management.

• Comply with federal, state and company policies, procedures and regulations.

• Maintains confidentiality of all information and complies with HIPAA regulations.

• Demonstrates knowledge of and supports Westbrook Health Services mission, vision, values, policies and procedures, operating instructions, confidentiality standards and code of ethical behavior.

• Facilitate and lead the Family Team meeting involving the youth, family, formal service providers (therapists, schools, case managers) and the informal supports (extended family, community).

• Conduct or coordinate assessments of strengths, needs, risks and resources

• Develop individualized wraparound care plans in collaboration with the family and team, based on assessment results and family goals/strengths

• Monitor and track the progress of the youth and family against the plan; revise the care plan when necessary

• Provide home visits and engage directly with families in their environment (as required)

• Engage and build community and natural supports (extended family, peers, community resources) to sustain supports over time

• Maintain accurate and timely documentation of services, meetings, outcomes and compliance with program and Medicaid requirements

• Travel within the service region as required (home visits, meetings with providers, etc)

• Participate in training, supervision and program quality initiatives

Requirements

Qualification Requirements:

• Must be able to communicate clearly and accurately with a variety of individuals in order to convey and receive information effectively.

• Must work well in a team environment.

• Work with staff, clients and others in a professional, cooperative, ethical, respectful and effective manner.

• Ability to work with a diverse group of people.

• Must have valid driver's license and clean driving record.

Education and/or Experience: Bachelors degree in Human Services discipline (Psychology, Criminal Justice, Regents with health specialization, Recreational therapy, Political Science, Nursing, Sociology, Social Work, Counseling, Teacher education, or Liberal Arts) or a Bachelor's degree in another discipline with a minimum of 12 credit hours in the human services disciplines listed previously. Prior computer/PC experience using computerized Medical Records and scheduling systems is preferred, but not required. Incumbent must also possess basic math skills. Must pass Criminal Investigation Background and DHHR background check as well as post offer drug screen.

Physical Requirements: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job while performing the responsibilities of the job, the employee is required to talk and hear. The employee is often required to sit and use his or her hands and fingers, to handle or feel. The employee is occasionally required to stand, walk, reach with arms and hands, climb or balance, and stoop, kneel, or crouch. Vision abilities required for this job include close vision. Must be able to travel within catchment area. Work is typically performed in an office environment or in the community.