Job Description

SIGN ON BONUS AVAILABLE!!!!
Providing evidence-based care coordination and management, ICP care coordinators ensure that more people in our communities can benefit from all exceptional health services.

JOB EXPECTATIONS
- Collaborates with the Enrollee's care team (registered nurse, PCP, PCA, medical director, behavioral health specialists, ACO's, DMH, CBHI, CBHC, medical supply stores, social workers, etc.)
- Encourages Enrollee to follow treatment recommendations through support, health and wellness education, and advocacy.
-Links enrollees with resources and encourage them to use them to their advantage.
- Utilizes recovery strategies such as Motivational Interviewing, Harm Reduction and Strength Based approaches to support enrollees in attaining stated goals.
- Conducts visits in the home or in other locations in the community to provide guidance, support, education, and coaching. Follow-up by telephone as necessary.
- Accompany/transport enrollees to medical/mental/behavioral health appointments as requested; facilitates effective navigation of the health care system
- LTSS Care Coordinators work with children ages 3 years old all the way up to adults who are 65 years old.
- Assists Enrollees in having an annual primary care visit.
- Completes Enrollee driven assessments, health screeners, Releases of Information and care plans annually. Complete daily activity notes in our electronic medical record.
- Ensures electronic medical record is up to date.
- Completes a face-to-face visit every 90 days.
- Ensures that Enrollee has an annual oral health evaluation.
- Participates in multi-disciplinary care team meetings.
- Ensures monthly contact with all enrollee's on caseload.
- Attends care team meetings, supervisions, Team meetings, MVP meetings, staff meetings, trainings, and various other meetings in regards to health care management.
- Manage a large caseload
- Maintain the ability to adapt and remain flexible with changing MassHealth, EOHHS, and CMS requirements and ongoing clarifications of the Community Partner Program
- Transports enrollees to connect with local community resources and to attend healthcare appointments.

QUALIFICATIONS
- Must have a vehicle available for work purposes that is registered and insured
- Must have a valid and active driver's license
- Bilingual and Bachelor Degree level applicants are encouraged to apply

PREFERRED
- CPR Certificate
- First Aid Certificate
- Medication Admin