Care Manager

Job Details:

Job Location:

New York, NY 10027, Position Type:
Full-Time, Salary Range: $24.73 - $24.73 Hourly,

Job summary:

Experienced Case Manager to work on a newly funded innovative Care Transition team that serves participants transitioning to the community from a higher level of care or those who remain unconnected to care due to their primary social and/or dwelling that is outside of shelter or permanent housing. As a member of the SOS multi-disciplinary team the case manager position will work under the supervision of the Program Director.

The role will involve facilitating transition from one level of care to the community by addressing the preparatory needs of participants in the early stages of recovery, discharge planning, development of daily living skills, and coping mechanisms through individual work in the community. The team will follow participants into the community using the SOS model of care (Critical Time Intervention) to ensure that they become both linked and engaged with identified community providers and that their support network is sufficient to meet their needs.

The role will require some on-call coverage and a willingness to work flexible hours if needed. The role also requires outreach in the community (both above and below ground) to engage individuals experiencing homelessness.

• Engagement beginning from referring location with involvement in transition planning, including a needs assessment of community transition supports essential to stabilizing the participant;
• Individual sessions with participants emphasizing prevention and preparing for independent community living and the promotion of optimum mental and emotional health. May require helping participants deal with issues associated with but not limited to family and social relationships; stress and symptom management; activities of daily living; medication management; and housing readiness;
• Work with participants and their housing providers to resolve clinical issues that are impacting on the participant’s ability to obtain, manage, and maintain supportive housing;
• Community navigation including accompanying to first behavioral health and medical appointment, travel training, reengagement in community care, referral to services with ability to identify and address potential services and barriers to obtain and maintain such services;
• Establish collaborative working relationships with referring treatment teams and other partners and plan with them for appropriate discharges for participants;
• Provide intense emotional and practical support to participants as they transition back into their communities;
• Provide on-call after hour crisis intervention services (when assigned) to participants and their support network, including respite referrals and other diversion and stabilization services;
• Attend and participate in team meetings and supervisory sessions;
• Review documentation and conduct comprehensive psychosocial assessments to determine the medical, psychiatric, housing and other social needs in the community;
• Develop short-term person-centered care plans to assist participant towards achieving their goals;
• In collaboration with credentialed colleagues, assesses and monitors participant behavior in accordance with 9.58 regulations;
• Participate in identifying available shelter/Safe Haven bed during canvassing activities;
• Monitor and record participant’s progress and modify plan according to needs and preferences;
• Timely and accurate documentation of participant information within the electronic platform
• Assist and instruct Participants in attending to daily living skills such as personal hygiene, grooming and laundry, nutrition/meal preparation, budgeting, and socialization tasks and skills…