Case Manager - Pathways to Recovery

801 Pennsylvania Ave SE
Washington, DC 20003, USA

POSITION TYPE: Hybrid

PAY RANGE: $48,000 - $59,000 depending on years of experience

POSITION SUMMARY

The Case Manager is part of Pathways to Recovery (PTR): A Reentry Diversion Initiative, an innovative, grant-funded forensic behavioral health program serving adults with serious mental illness and co-occurring substance use disorders transitioning from incarceration to community living. The Case Manager provides intensive, community-based behavioral health case management services to adults with serious mental illness and co-occurring substance use disorders who are transitioning from incarceration to community living.

Using a trauma-informed, recovery-oriented, and person-centered approach, the Case Manager supports participants throughout critical transition periods, helping them access behavioral health treatment, primary healthcare, housing, benefits, employment supports, and community resources. The position utilizes Critical Time Intervention (CTI) principles and forensic behavioral health practices to improve continuity of care, promote recovery, reduce justice-system involvement, and support successful community reintegration.

Note:

This position and program require availability of grant funding.

KEY RESPONSIBILITIES

CASELOAD EXPECTATIONS

• Maintain an active caseload of approximately 20-25 participants.
• Provide person-centered, intensive support during pre-release planning and the first six months following community reentry, especially the first 30 days in the community.
• Adjust service intensity based on participant needs and risk factors.

PARTICIPANT ENGAGEMENT AND ASSESSMENT

• Engage individuals prior to release from incarceration and establish therapeutic relationships that support successful reentry.
• Identify barriers to successful community integration and develop individualized service plans.
• Incorporate participant goals, preferences, cultural factors, and recovery objectives into care planning.
• Utilize trauma-informed and motivational interviewing techniques to enhance engagement and retention.

CARE COORDINATION AND CASE MANAGEMENT

• Develop and implement individualized transition and recovery plans.
• Coordinate behavioral health, substance use treatment, primary care, psychiatric, and social service appointments.
• Facilitate linkages to:
  Medicaid and eligible insurance, Community behavioral health providers, Medication management services, Primary care providers, Housing and supportive housing programs, Employment and vocational services, Benefits and entitlement programs, Financial assistance resources, Peer support and recovery services
• Ensure participants maintain access to essential services during critical transition periods.
• Monitor participant stability and identify emerging behavioral health concerns.
• Support with crisis intervention.

COMMUNITY-BASED SERVICE DELIVERY

• Provide services in community settings, including participant homes, shelters, correctional facilities, treatment programs, hospitals, and other community locations.
• Maintain frequent contact with participants during high-risk transition periods.
• Accompany participants to appointments when clinically indicated.
• Assist participants in developing independent living and community integration skills.
• Support medication adherence and treatment engagement.
• Conduct outreach and re-engagement activities for participants who disengage from services.

CRIMINAL JUSTICE AND SYSTEM COLLABORATION

• Coordinate services with correctional facilities and criminal justice stakeholders.
• Collaborate with probation officers, legal representatives, and community supervision agencies.
• Participate in multidisciplinary meetings regarding participant care and transition planning.
• Support diversion and reentry objectives via consistent communication with system partners.
• Advocate for participant access to services and community supports.

DOCUMENTATION, COMPLIANCE, AND QUALITY

• Complete required documentation within established time frames.
• Maintain accurate participant records consistent with agency, regulatory, and funding requirements.
• Document assessments, service plans, progress notes, referrals, and outcomes.
• Participate in chart reviews, audits, and quality improvement activities.
• Utilize electronic health record systems and data tracking tools.
• Participate in individual and group supervision.
• Attend required trainings and professional development activities.
• Contribute to program evaluation, and quality improvement initiatives.
• Assist with…