Care Coordinator, Patient Centered Care

The Care Coordinator, in collaboration with Thresholds Community Support teams and Patient Centered Care (PCC) Wellness Clinics,provides care coordination, case management and linkage for Thresholds members who are also receiving care at PCC clinics, to resources designed to improve social determinants of health, with an emphasis on those who are Medicaid eligible under the Affordable Care Act, and need assistance with maintaining Medicaid coverage and access to care. The Care Coordinator assists Thresholds Community Support teams and PCC in implementing program improvements that strengthen care management, member access, and health outcomes. This role is responsible for developing and maintaining data tracking and reporting in alignment with the Mental Health Expansion Initiative grant.Position reports to either Assistant Program Director or Program Director.

ESSENTIAL DUTIES & RESPONSIBILITIES

• Reports to the Program Director and works in collaboration with the Assertive community Treatment (ACT), Community Support Team (CST), and Community Support Individual (CSI) teams to coordinate healthcare with PCC and maintain Medicaid eligibility.
• Attends team and program meetings.
• Attends PCC integration, coordination, and collaborative care meetings.
• Assists with navigating systems and maintaining entitlements including Social Security Income (SSI) and Medicaid, Managed Care Medicaid, including completing Social Security Income/Disability Outreach, Access, and Recovery (SOAR) applications for SSI/SSDI and keeping eligibility requirement documentation up to date to maintain Medicaid eligibility and coverage.
• Assists members with managing PCC healthcare appointments and relevant follow up, including managing prescriptions, referrals to specialty care, and follow up appointments with Primary Care Physician (PCP).
• Follows up with other collateral providers and community resources to coordinate care.
• Develops tracking system to help teams manage redetermination dates, documentation, and appointments to maintain benefits, and other related data.
• Collaborate with Program Director, Vice President, Clinical Operations Director Integrated Partnerships, and Senior Vice President, Clinical Operations.

EDUCATION

• Must, at a minimum, meet Office of Mental Health Rule 132 credential requirements for a Mental Health Professional.
• Qualified Mental Health Professional including a Master's degree in social work, counseling, psychology, or closely related field preferred.

EXPERIENCE

• Experience collaborating with persons diagnosed with mental illness preferred.
• Ability to document services provided in an Electronic Health Record in a timely manner.
• Daily access to a personal vehicle is required. Must obtain and maintain $100,000/$300,000/$100,000 bodily injury and liability insurance. Subject to validation every six months.
• May be required to provide transportation for members of the program using a Thresholds provided vehicle or personal vehicle. Must be 23 years of age and must meet all insurance carrier's requirements. Subject to annual Department of Motor Vehicles license verification.

What sets Thresholds apart:

• Competitive pay - Pay Range: $50,440 - $60,000
• Based on education, experience, and licensure/certifications
• Generous PTO
• Dental insurance, vision insurance,4 medical insurance plans
• 403(b) retirement plan with 3% employer match
• Robust employee assistance program (EAP)
• Mileage reimbursement
• Public service loan forgiveness
• Cell phone reimbursement (up to $50/month)
• Supervision for clinical licensure at no cost (LSW, LCSW, LPC, LCPC)
• Reimbursement for professional licensure and license renewal

Thresholds is a mission-driven agency with a deep commitment to fostering an environment where all feel valued and respected, a place where every employee can be themselves, thrive, and support the agency's mission. Click here to learn more.

One of the oldest and largest community mental health organizations in Illinois, we pride ourselves in being a Chicago Tribune Top Workplace and one of Chicago's 101 Best & Brightest Companies to Work For, several years in a row.