The Care Coordination program offers services to adults and children ages 6 to 18 enrolled in the Coordinated Behavioral Care (CBC) Health Home Program with a history of serious mental illness and/or multiple hospitalizations. The goal is to connect clients and families to various community resources identified as beneficial to the clients' overall holistic well-being in order to reduce emergency room visits, inpatient stays and criminal justice involvement.
STATEMENT OF THE JOBUnder the direction of the Director of Care Coordination, the Clinical Director has responsibility for administrative and managerial operations of CCNS's Non-Medicaid Care Coordination Program under the NYC Department of Health and Mental Hygiene (DOHMH). The position entails program oversight inclusive of staff training, development and revision of systems for program operations and administration, ongoing integration of program-specific policies and procedures, budget planning, integration of health information technology, and community engagement. The Clinical Director will be responsible for ensuring contract deliverables are met. This includes overseeing appropriateness and effectiveness of care management services, identification of gaps in service delivery system, representing the Agency at meetings, conferences and public forums, strategic planning and implementation, and program development - including monitoring revenue, expenditures, client monies, productivity and outcomes, regulatory requirements and audit readiness.
The Clinical Director will lead program's efforts for client-centered and recovery-oriented care and plays a vital role in ensuring both the Care Coordination program meets health outcomes for clients such as reducing hospitalizations and emergency department visits, while increasing attendance and engagement with behavioral health and medical outpatient services. The Clinical Director is responsible for ensuring direct service staff address all social determinants of health such as medical needs, behavioral health and substance use needs, housing, food insecurity, education/employment. This is done through partnerships and integrated work with other community-based providers, hospitals, and other systems of care to ensure clients have access to a comprehensive healthcare network. The Clinical Director is responsible for direct client services as a member of the clinical staff, clinical supervision for staff, and administration and leadership of the team, on an ongoing basis. The role will also require on call coverage and a willingness to be flexible as the program operates 24/7.
DUTIES AND RESPONSIBILITIES- Management and oversight of the day to day activities of the Non-Medicaid Care Coordination program in accordance with internal and external regulatory standards and guidelines.
- Ensures that programmatic systems are in place and functioning to meet client needs.
- Manages and adheres to program budgets, meeting productivity and revenue targets and monitoring expenses.
- Responsible for management of client wrap-around funds budget and adherence to contract guidance on how client monies may be utilized.
- Monitors and oversees all aspects related to the delivery of care coordination ensuring access to a comprehensive array of services and continuity of care across all care transitions.
- Counsel in individual or team settings with emphasis on recovery and supporting independent community living while promoting optimum mental and emotional health. May assist clients in dealing with issues associated with but not limited to family and social relationships, stress and symptom management, entitlements, activities of daily living, medication management, and housing readiness.
- Participate in case conferences to help identify community health needs and tailor services to meet these needs.
- Complete client assessments and develop care plans as needed. Ensure staff meet assessment requirements for DOHMH.
- Coordinates promotion of evidence-based wellness and prevention activities of teams for linking care coordination members with resources for smoking cessation, diabetes, asthma, hypertension, self-help recovery resources, and other medical services based on individual physical needs and preferences.
- Oversees program activities in identifying the primary care physician and multidisciplinary teams of medical, mental health, chemical dependency treatment providers, social workers, nurses nutritionists/dieticians, pharmacists, outreach workers including peer specialists and other care providers to assure that care coordination clients receive needed medical, behavioral, and social services in accordance with a plan of care.
- Work with all stakeholders (members, network, families, and government staff) in a caring and respectful manner, and with due understanding of and consideration for cultural differences.
- Assures timely and comprehensive transitional care from an inpatient facility (hospital, rehabilitative, psychiatric, skilled nursing or treatment facility) to follow-up with post discharge interventions to prevent avoidable readmission after discharge and to ensure proper and timely follow up care.
- Tracks and shares care coordination members' information and care needs across providers by utilizing electronic databases and monitors team's outcomes and initiate changes in care, as necessary, to address members' needs.
- Oversee required documentation in CAIRS database, internal EHR, AOT portal and MAVEN portal used by SPOA for all referrals and census tracking.
- Manage incoming referrals through internal EHR, via CCNS Call Center, and through upward enrollments directly from community, self-referrals, hospitals and other providers. Conduct in-reach to hospital settings, schools and other provider settings as needed to ensure program meets census requirements.
- Collects, analyzes and reports data, as required, and specifically regarding frequency of member contacts, levels of service monthly, frequency of hospitalizations and ER visits, and overall productivity related to identified outcomes measures. Responsible for timely and accurate submission of all required program reports.
- Coordinates strategic planning, development and implementation of processes and services that will improve the service delivery system and program productivity.
- Identifies, develops and implements quality improvement projects and plans to solve problems/issues.
- Ensures intra-program collaboration and inter-agency collaboration including participation in linkage meetings with other care coordination providers.
- Responsible for ensuring that program reports incidents in accordance with CCNS and funding source guidelines.
- Cooperates and actively participates in all investigations conducted by the Agency, funding sources and any other authorized agencies/entities.
- Facilitate and lead weekly staff and clinical meetings. Facilitate and monitor the organizing of team member's schedule, assisting with time management as needed.
- Provide weekly supervision to team members and orienting new team members to policy and procedures as well as ongoing training and mentorship.
- Manage interviewing and hiring staff, as well as addressing staff performance-related issues in accordance with salient policies and procedures, in accordance with agency procedures.
- Assign caseloads to team members and monitor staff schedules.
- Manage teams on-call duties and ensure 24/7 crisis response availability and provide crisis intervention services on a rotating basis, including referrals to respite and other resources
- Assume on-call administrative and crisis evening and weekend duties.
- Collaborates with agency and program staff to develop and adhere to on-site emergency response preparedness and readiness protocols.
- Awareness, preparation and participation in internal and external audits. Assures that program is always audit ready. Develops Corrective Action Plans related to audit and/or Quality Assurance activities, including implementation of the Corrective Action Plan at the program level.
- Reports to Integrated Health and Wellness administration and/or Agency administration issues that may have a negative impact on the reputation of the Agency, client and/or staff welfare or any corporate compliance issue.
- Participates in CCNS corporate compliance training and all other required trainings.
- Collaborate with Agency administration in the identification of new markets and developing marketing strategies.
- Involvement in the RFP process, CQI initiatives and other grant initiatives as needed.
- Ensure program compliance with fire, safety, and health standards as per licensing and or quality assurance requirements and standards.
- Contribute to the development of treatment protocols, clinical pathways and policy papers as needed.
- Other duties as assigned.
SPECIFICATIONS FOR EDUCATION/CERTIFICATIONS/LICENSES- Master's Degree in Social Work, Nursing, Public Health or other related social service or health profession.
- Licensing in a related field of practice (LCSW, LMSW, LPN, RN, NP) preferred.
SPECIFICATIONS FOR EXPERIENCE AND TRAINING- Three (3) years of experience in the management of programs with progressively increasing responsibilities.
- Demonstrated competency in written, verbal and computational skills to present and document records in accordance with program standards.
- Experience as a manager that preferably included responsibility for program design, implementation, and evaluation.
- Report-writing and data analytics skills.
- Superior communication and writing skills.
- Preference will be given to candidates who have experience serving and/or developing systems who serve persons with chronic health conditions, behavioral health conditions, persons experiencing homelessness, and persons with benefits/entitlements needs.
- Knowledge of mental illness, mental health legislation and regulations, and health conditions.
- Knowledge of Microsoft office applications, including Excel.
- Ability to manage multiple projects and ask for help when needed.
- Ability to independently manage resources, which includes money, material, time, and people.
- Ability to participate on a team to accomplish tasks.
- Serves as a role model to staff and stakeholders.
- College-level problem solving ability.
- Refined knowledge of techniques for identifying and preventing crises, including crisis management techniques.
- Ability to work with all stakeholders: members, network, families, and government staff in a caring and respectful manner, and with due understanding of and consideration for cultural differences.
- Competency in written, interpersonal, verbal and computational skills to present and document records in accordance with program standards.
- The position requires a combination of skills in the following areas; administrative and clinical supervision and practice, design, operational oversight and evaluation of program services and staff, personnel management, budget development and control, property management, public relations, governmental relations, leadership development and team building skills.
- Must be comfortable with public speaking, lobbying and advocacy, ability to train and educate staff.
- Able to utilize technology conferencing tools including audio, video and /or web deployed solutions and accountable for hand-held devices (I Phone, Blackberry, I Pad, Tablets, Laptops, etc.)
SPECIFICATIONS FOR PHYSICAL REQUIREMENTS- Regularly required to talk, hear, walk, stand, & sit.
- Able to lift up to 10 pounds.
- Able to meet with residents and/or staff throughout facilities.
- Able to operate a computer keyboard, mouse, & office equipment.
- Frequent sitting to write reports.
- Able to read printed materials and computer screens.
- Able to travel to multiple locations as needed.
- Able to work flexible hours and days - including weekends/evenings/holidays according to needs of program.
BENEFITSWe offer competitive salary and excellent benefits including:
- Generous time off (Vacation/ Personal Days/ Sick Days/ Paid Holidays annually)
- Medical,
- Dental
- Vision
- Retirement Savings with Agency Match
- Transit
- Flexible Spending Account
- Life insurance
- Public Loan Forgiveness Qualified Employer
- Training Series and other additional voluntary benefits.
For more information on our organization, please visit our website at:
www.ccbq.org
