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Client Care Coordinator – Peer Self Help Program

STATUS – OPEN

Title: Client Care Coordinator – Peer Self Help Program (funded through the NYS Office of Mental Health (OMH))

Reports To: Client Care Supervisor

FLSA: Non-Exempt

Status: Full-time

Supervisory Responsibility: Not Applicable

Purpose of the Role:
Provide critical self-help/peer support for the purpose of preventing hospitalization or re-hospitalization for individuals with serious mental health issues. The program will offer self-help/peer advocacy and support for individuals in OMH licensed residential programs and non-residential programs.

Essential Functions of the Role:

  • Upon receiving the referral from the Social Worker of a participating entity, schedule an appointment within 72 hours to meet in person with the client and their assigned Social Worker. Introductory meeting will explain the program, what services can and cannot be provided and build rapport.
  • Open case file in the case management system immediately after introductory meeting. Maintain case notes accordingly.
  • If the client is still inpatient, meet in-person minimally 2x’s per month to build rapport, assess their needs and begin to sketch out a care plan based upon their release date.
  • As client nears the release date, partner with all related collaterals to coordinate discharge care plan.
  • Upon discharge, self-help support engagement involves the following areas:
    • Assistance with daily management: Peer supporters using their own experiences with diet, physical activity and medicine adherence in helping people figure out how to management mental health issues in their daily lives. They can also help in identifying key resources, such as where to buy healthy foods or pleasant and convenient locations exercise.
    • Social and emotional support: Through empathetic listening and encouragement, peer supporters are an integral part of helping patients to cope with social or emotional barriers and to stay motivated to reach their goals.
    • Linkages to clinical care and community resources: Peer supporters can help bridge the gap between the client and the health professionals and encourage individuals to seek out clinical and community resources when it is appropriate.
    • Ongoing support, extended over time: Peer supporters successfully keep patients engaged by providing proactive, flexible, and continual long-term follow-up.

On an on-going basis:

  • Set client goals.
  • Align care activities with client goals.
  • Monitor progress of goals, adjust care needs accordingly.
  • Submit reports in a timely and thorough manner as required by the program and the Agency.
  • Review assigned case load with Client Care Supervisor 2 times per month to ensure effective case management (as noted above); make adjustments as needed.
  • Acting as an advocate, develop productive and results oriented relationships with mission critical persons at outside organizations, such as (but not limited to): Dept. of Social Services, Mental Health Providers, Primary Care Physicians, Probation Officers, Legal Services, District Attorney’s Office, etc.
  • Using the full capacity of one’s ongoing experience and training, demonstrate progressive ability to problem solve, advocate, mediate and handle increasingly complex tasks related to care coordination.
  • Do not settle for “because that’s the way it has always been done”, rather be fearless in the pursuit of excellence and achieving the needed outcomes for our clients and the agency at large.
  • Other Health Home clients as assigned, and abiding by all care coordination criteria as required.
  • Other tasks as assigned.

Decision Making Authority:

Decisions regarding client care and case management are to be made with guidance and collaboration of the Client Care Supervisor to whom the Client Care Coordinator (CCC) is assigned. It is expected that the CCC will show an increasing ability to make decisions independently on routine matters as knowledge and experience progresses.

Working Relationships:

  • Internal: Client Care Supervisor, Program Director, other CCC’s
  • External: Dept. of Social Services, Mental Health Providers, Primary Care Physicians, Probation Officers, Legal Services, District Attorney’s Office, etc.

Work Schedule: Monday – Friday, 9am-5pm, with some flexibility around client needs.

Physical Environment:

  • Traditional office environment.
  • Must be comfortable attending appointments at various agencies, facilities and client’s homes.

Physical Demands: Must be able to drive a motor vehicle and carry up to 20 lbs.

Mental and Visual Demands: Flow of work and nature of duties involve normal coordination of mind and eyes much of the time.

  • Must be able to interact with persons having mental health issues, periods of instability (i.e. lack of shelter, food, clothing or support), recently released from an institution (i.e. hospital, prison), limited comprehension and/or ability to manage through complex scenarios.

Qualifications for this Role:

  • CHOICE is a peer organization. Persons who work on the Peer Self Help team must have direct experience with a mental health condition, a period of hardship (i.e. homelessness, imprisonment) or a disability.
  • Proven ability to empathize with the clients we serve.
  • Tenacity and passion for this work with the ability to balance objectivity with empathy.
  • Computer literacy required.
  • Valid NYS Driver’s License required and a driving record that will permit the use of an Agency vehicle to transport clients to appointments or other activities as needed.
  • HS Diploma or GED required.
  • Associates or Bachelor’s Degree a plus.
  • Bilingual English/Spanish a plus.

To submit an application, please email careers@choiceofny.org.