AOT/ Health Home Plus Care Manager

Job Title: AOT Health Home Plus Care manager

Reports to: Care Management Supervisor

Job Category: Non-Exempt

Department: Care Management

Rate: 22.50 Per hour

Position Overview:

Provides person-centered service to assigned caseload of adult Assisted Outpatient Treatment (AOT)/HH+ "petition" or "diversion" status consumers. Services include comprehensive assessment and evaluation, care planning and coordination, outreach and crisis intervention, linkage to medical, financial, social, rehabilitation and psychiatric services, advocacy, development of social supports and procurement of needed resources. Performs recordkeeping/documentation, statistical, tracking and quality assurance activities.

Duties and Responsibilities

• Provide outreach, engagement, and enrollment activities concerning referred for AOT services.
• Provide comprehensive assessment and service planning with AOT consumers.
• Be able to manage caseloads that vary from 12-15 persons; each requiring a minimum of 4 face-to-face visits per month.
• Provide additional Care Management activities that include mailings, electronic communications and telephone calls with consumers, their families/significant others, and various community service providers.
• Develop, monitor, and periodically update a comprehensive, individualized, consumer centered Plan of Care that will integrate the individual's AOT plan with medical and behavioral health services, rehabilitative, long-term care, social service needs as applicable.
• Advocate, monitor health and medication adherence, arrange for/transport to medical appointments, connect to entitlements; facilitate vocational/educational goal support, recreation/leisure skill development; assist with apartment finding and set-ups and landlord relations.
• Communicate with ECDMH or NYSOMH as needed to assure comprehensive servicing and reporting out on AOT consumers on a timely basis.
• Work effectively within the AOT/HH+ Care Management Team to provide necessary services to all consumers attached to the team to ensure 24 hour, 7 day a week coverage.
• Maintain audit-ready charts that include required assessment, service planning and Contact Notes, and other forms as required.
• Input and retrieve electronic data from various systems including database and web-based systems; especially the NYSOMH CAIRS system.
• Respond on a timely basis to telephonic, e-mail, or other communications related to consumers, internal correspondence, or outside communications related to the AOT/HH+Care Manager position.

Knowledge and Skill Requirements

Education: A bachelor's degree featuring a major or concentration in social work, psychology, nursing, rehabilitation, education, occupational therapy, physical therapy, recreation or recreation therapy, counseling, community mental health, child and family studies, sociology, speech and hearing or other human services field. or A NYS teacher's certificate for which a bachelor's degree is required; or NYS licensure and registration as a Registered Nurse and a bachelor's degree; or A Bachelor's level education or higher in any field with five years of experience working directly with persons with behavioral health diagnoses; or A Credentialed Alcoholism and Substance Abuse Counselor (CASAC).

AND Experience: Two years of experience: In providing direct services to people with Serious Mental Illness, developmental disabilities, or alcoholism or substance abuse; or In linking individuals with Serious Mental Illness, developmental disabilities, or alcoholism or substance abuse to a broad range of services essential to successful living in a community setting (e.g. medical, psychiatric, social, educational, legal, housing and financial services). A master's degree in one of the qualifying education fields may be substituted for one year of Experience.

AND Must have use of an automobile and valid driver's license.

Other Skills/Abilities

• Ability to work independently and initiate change.
• Possess an even temperament.
• Have strong organizational and time management skills.
• Work effectively within a team setting.
• Have superior interpersonal skills in collaborating with other providers and consumer centered community support systems.
• Value cultural difference, collaborative efforts, and person-centered services.
• Demonstrate excellent verbal and written skill.
• Strong negotiation, judgment, problem solving, and time management skills are essential to success at this position.

Reporting Relationships

The AOT/HH+ Care Manager receives direct clinical and administrative supervision from the Team Leader or Care Management Team Supervisor.