Care Specialist II N

For over 125 years, Catholic Charities Brooklyn and Queens has been providing quality social services to the neighborhoods of Brooklyn and Queens, and currently offers 160-plus programs and services for children, youth, adults, seniors, and those struggling with mental illness. Catholic Charities provides individuals with serious mental illness, complex medical needs and substance abuse issues with comprehensive care coordination and case management services.

Our Care Coordination Program works with Health Homes to deliver comprehensive, community-based services for adults with Medicaid, living with serious mental illness, and ensures clients have access to uninterrupted and coordinated behavioral and physical health services while addressing the social determinants of health that impact daily living. Care Specialists address a host of issues that impact clients directly such as housing, access to nutritious food, economic security/benefits, medication adherence, linkage with outpatient treatment providers or other community resources and social supports.

This position works with our highest need population, Health Home Plus (HH+).

Under the direct supervision of the HH Team Supervisor, the Care Specialist II has overall day-to-day responsibility and accountability for coordinating all aspects of care for assigned health home serving children members with complex medical and/or psychiatric co-morbid conditions and for facilitating their access to the full range of medical, behavioral health, substance use, social and psychosocial services in the community, in an efficient and effective manner.

Duties of the Care Specialist II focus on integration and coordination of physical health, mental health and social service needs. The Care Specialist II has to become an active participant in all phases of care transition to assure that members receive all required mental and medical follow up care and services and must also take action around re-engagement of members who have become lost to care.

The Care Specialist II electronically monitors and tracks data regarding health home member and alerts all members of the Care Team when follow-up is required.

• Demonstrates commitment to the vision of Health Home and strategic priorities to ensure their achievement.
• Accountable for engaging and retaining Queens health home members in care, coordinating and arranging for the continuous provision of services, supporting adherence to treatment recommendations, monitoring and evaluating their needs, including prevention, wellness, medical, specialist and behavioral health treatment, care transitions, and social and community services where appropriate through the creation of an individual plan of care.
• In collaboration with the health home members, their family and/or caregivers, and other service providers develops, manages and coordinates a comprehensive individualized person-centered care plan that coordinates and integrates the continuum of medical, behavioral health services, rehabilitative, long term care and social service needs and clearly identifies the primary care physician/nurse practitioner, specialists, behavioral health care providers, care manager and other providers directly involved in the individual’s care.
• Ensures the availability of priority appointments for health home members to care services including physical, psychiatric, and substance abuse within their health home provider network to avoid unnecessary, inappropriate utilization of emergency room and inpatient hospital services.
• Promotes evidence-based wellness and prevention by linking health home members with resources for smoking cessation, diabetes, asthma, hypertension, self-help…