Care Coord​/Intensive Coordinator

Care Coordination and Support:
Intensive Care Coordinator (CCSI)

Pathways to Success is a highly structured program implemented by HFS. Pathways to Success is for individuals under the age of 21 that are Medicaid eligible and meet criteria based on the Behavioral Health Decision Support Model. Intensive case management and full wraparound services are offered to clients and families identified as Pathways eligible. Pathways Care Coordinators link families to traditional outpatient services as well as Pathways specific services.

The Coordination and Support:
Intensive Care Coordinator (CCSI) takes primary responsibility for making the care coordination process happen for children with a mental health diagnosis and their families through the facilitation of Child and Family Team Meetings, coordinating with professionals, and helping the child meet their goals. CCSI is provided to children stratified into Tier
2. Designated CCSI Care Coordinators work with an average of 16 families (based on population) at a time and are never assigned to work with more than 18 families  CCSI helps the family develop a positive view of their future and learn how to use the strength‑based empowerment model to help their child improve functioning in the home, school, and community.

• Perform outreach & engagement to locate, engage, and educate Pathways youth and their families. Outreach is required 3 times a week for 60 days or until the client is enrolled or they decline Pathways services.
• Using a trauma‑informed approach and effectively engaging children/youth with significant behavioral health needs and their family/caregivers to resources within the community for their assigned caseload.
• Provide intensive care coordination: utilize a strengths‑based approach to safety planning, development of family team and family support systems, and wraparound planning for the purpose of maintaining children in their homes, schools, and communities.
• Schedule, plan and facilitate Child & Family Team Meetings.
• Build and maintain knowledge of available community resources and helps link youth and family to needed supports.
• Provide regular communication and close collaboration with multiple community partners.
• Using a system of care approach, assist families to coordinate services from community resources, placement providers, collateral agencies, the court, and/or other community partners with families, clients, or patients receiving services.
• Facilitate the creation of safety and crisis prevention plans.
• Collaborate with local MCR agencies (including Ada S. McKinley’s MCR team) when necessary.
• Enact Ada S. McKinley Care Coordination Model with each individual and family.
• Facilitate the application process and obtain consents for SFSP/FSP for eligible youth and their families.
• Provide care coordination services to SFSP/FSP eligible youth and their families.
• Complete service documentation in alignment with agency and program core performance standards.

• Helping find services and supports in the person‑served community or natural environment.
• Good writing skills in order to complete required documentation.
• Strong organizational skills.
• Self‑starter and multitasker.
• Exceptional customer service skills.
• One‑two years of experience managing large case loads.
• Prepare detailed documentation of activities including opening and closing electronic records, completing required assessments, creating, and updating Wraparound Plans, and ensuring access to…

• Provide a high‑level of customer service and client engagement.
• The ability to learn through in‑person, virtual, and web‑based trainings.
• Must be organized, able to meet timelines, manage a case load, and be a self‑starter.
• Have strong interpersonal skills and the ability to collaborate and partner with families, children/adolescents, and other professionals.
• Maintain caseload of 1:18 (based on population).
• Performs other related tasks as needed.

Education:

Bachelor’s degree in social work, counseling, rehabilitation counseling, vocational counseling, psychology, pastoral…