Part Time Health Home Care Coordinator

Organization

People USA – Non-Profit Peer Run Behavioral Health, Mental Health, Recovery, Wellness

Putnam County Health Home Care Coordinator

Garrison, NY

Monday through Friday – 9:00 AM to 1 PM (20 Hours Per Week)

$24.50 per hour

The Putnam County care coordinator will work with Medicaid-enrolled individuals, living with mental illness or multiple chronic conditions, to get connected to care and services in their local communities. By connecting high-risk Medicaid individuals to resources and supports, we aim to reduce duplicate services, reduce emergency department visits and inpatient admissions, and lower costs, thus improving the health and well‑being of lives throughout Putnam County.

The population served has unmet mental health, addiction, or social determinant of health needs and does not typically engage with the traditional systems of care. The goal of the care coordinator will be to work with the participants and their care team in supporting individuals to identify goals and make connections to needed services. This is a part‑time position for approximately six months, with the expectation of transitioning to full‑time status as the caseload allows.

• Assists participants with psychiatric diagnoses to participate in diverse, person‑centered, self‑directed services and meaningful activities that promote empowerment and robust recovery.
• Collaborating with the SPOA (Single Point of Access) for referrals.
• Maintains regular contact, outreach, curriculum development, group facilitation, counseling, mentoring, systems navigation, community oversight, and crisis support.
• Provide Care Management outreach and engagement with eligible individuals in coordination with the Institute of Family Health and Care Management Partners of Ulster County.
• Provide screenings and evaluations using trauma‑informed, person‑centered skills with the Institute of Family Health’s service tools, along with individual advocacy, peer support and systems navigation.
• Educates participants on useful health & wellness topics, including but not limited to Peer/Self‑help, smoking cessation, and advocacy.
• Helps participants identify barriers to their recovery journeys or personal wellness, including access, quality of care, people’s rights, lack of basic needs, and stigma & discrimination.
• Advocates for participants side‑by‑side to overcome identified barriers, making sure their voices are heard, and their decisions are understood and respected.
• Builds peer‑to‑peer connections/relationships based on mutuality (shared lived experiences), empathy, and hope for recovery/wellness (peers‑as‑proof).
• Develops and maintains positive working relationships with other provider agencies and local housing providers (landlords) within the county and its surrounding environments.
• Documents all meaningful interactions with participants in electronic records software and maintains hard copies in participants’ files daily for audit purposes and submits monthly reports.

• This position requires a thorough understanding of the process and the possibility of robust recovery for people diagnosed with psychiatric disabilities. People with personal experience as a recipient of mental health services and/or of personal recovery are preferred.
• Knowledge of ADA, mental health laws and systems, Social Security Programs, Work Incentives, Entitlement Programs, supported employment, Federal/state/local services, laws, and systems related to individuals with disabilities.
• Demonstrated ability to recognize the need for and facilitate connections between participants and services.
• Excellent written and verbal presentation skills.
• Ability to obtain the NYS Peer Specialist Certification within 6 months of active employment.
• MUST HAVE A VALID AND CLEAN DRIVERS' LICENSE.