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The Care Coordinator is responsible for providing care coordination to the identified population with chronic mental illness, multiple physical health conditions and high ED utilization. The goal of care coordination is to reduce unnecessary contacts with emergency departments and unnecessary inpatient hospitalizations while removing barriers to outpatient services and healthy outcomes. This position is the result of the Jefferson County Hotspotting Alliance; a collaboration between Arapahoe House, Colorado Community Health Alliance (CCHA), Jefferson Center for Mental Health (JCMH), Lutheran Medical Center, Metro Community Provider Network (MCPN) and St. Anthony Hospital. The Care Coordinator will be employed and supervised by Jefferson Center and will receive support from the members of the alliance.
- Completes comprehensive assessments to identify needs and barriers to the member’s abilities to manage their medical conditions and assists in completion of member and provider driven treatment plan/goals.
- Provide appropriate linkages, referrals, coordination, and follow-up for patients to services and supports, including referrals and linkages to long term services and supports and community agencies.
- Provide health care appointment scheduling for patients to primary care providers, mental health, and specialists.
- Ensure patient has adequate transportation to and from appointments.
- Develops strong in-person and telephonic relationships with the member, providers, and community resources.
- Participate in hospital discharge processes and communicate with providers and family members/support system.
- Communicate and collaborate with hospital emergency department staff to ensure the coordination of patient care and treatment.
- Assist patients in obtaining necessary medications and increasing medication compliance.
- Work closely with community resources and organizations in coordinating client services.
- Advocate for patients who may be vulnerable or need additional support.
- Complete and file all documentation as required in a timely manner.
- Ensure releases of information and other required documents are completed and filed.
- Attend provider team meetings to promote collaboration of service and treatment providers.
- Attend and participate in individual and/or peer supervision as directed.
- Accomplish all tasks as appropriately assigned or requested and maintain a caseload average of 25 members.
- Support hospital case managers and emergency departments in coordination and referrals to resources as needed.
Skills / Requirements
- Requires a Masters degree in Social Work or related field, LCSW, LPC preferred.
- Five (5) years Social Work/Case Management experience with at least one (1) year experience in community setting (i.e. home health care, discharge planning, department of social services etc.).
- Reliable insured personal transportation, a valid driver’s license and ability to travel 25-50% of time in Denver and surrounding areas.
- Home office space that is HIPAA compliant.
- Excellent verbal and written communication skills and the ability to convey information clearly to both internal staff and external members/partners.
- Intermediate level of competence on computer and internet skills required for routine data collection, data entry and reporting; intermediate experience with Microsoft Outlook, Microsoft Word and Microsoft Excel spreadsheets.
- Ability to work well in group and independent problem-solving situations.
- Excellent time management skills and ability to complete tasks on time; ability to multi-task.
- Completion of documentation and HIPAA training.
- BLS certification or willingness to complete.
For consideration, submit a cover letter and your resume online today.
Please use the form below to apply.
Jefferson Center for Mental Health is dedicated to the principles of equal employment opportunity in any term, condition, or privilege of employment. We prohibit unlawful discrimination against applicants or employees on the basis of age 40 and over, race, sex, color, religion, sexual orientation, gender identity and expressions, national origin, disability, genetic information, or any other applicable status protected by state or local law.
Jefferson Center is a tobacco free agency. Tobacco use is not permitted on our premises.