Service Coordinator I, Care Coord Comm Supports & Pasadena

SC I, Care Coord Comm Supports & Pasadena Full Time Professional Los Angeles, CA, US Salary Range: $25.48 To $27.88 Annually Community Supports and Pasadena COC ICMS REPORTS TO : Program Manager of Housing Services CLASSIFICATION: Non-Exempt SUMMARY: CalAim Community Supports (CS) is a program supporting unhoused and recently housed individuals funded through California Advancing and Innovating Medi-Cal (CalAlM). It coordinates care by utilizing a person-centered approach to maximizing an individual's health and life trajectory. The program will offer the following 3 Community Supports: Housing Transition Navigation Services, Housing Deposits, and Housing Tenancy and Sustaining Services. Step Up will begin outreach and engagement to promote the services, enroll the members in the CalAlM - CS program, and provide supportive services intended to improve their current housing situation as well as improve their social and physical determinants of health. Members remain in the CS program until they no longer need or want the services. CS services consist of a care team providing in-person supportive services that aim to identify and manage comprehensive needs through improving health outcomes, providing housing support, and addressing social drivers of health. The Pasadena COC ICMS program is designed to provide long‑term supportive services and housing stabilization to the Pasadena Housing Division voucher holders. SCIS working with this population will provide case management and linkage, housing navigation, supportive services, and housing retention services to participating voucher holders enrolled in this program. Step Up fully implements the Housing First and Harm Reduction models of service delivery and using the "WHATEVER IT TAKES" approach. The CS and Pasadena COC ICMS Service Coordinator I (SCI) will provide support to both CalAim CS and Pasadena COC ICMS enrolled members. Benefits and What We Offer: Opportunities for growth and professional development. Generous paid time off (13 paid holidays, 10 days of EPTO, 12 sick days). Competitive salary and benefits package. Health, dental, vision, Aflac, and life insurance $25,000.00 403(b) retirement plan available on the first day of work. After working 1000 hours, Step Up matches 3% of the 6% the employee contributes. DUTIES: The following reflect essential functions for this job but does not restrict other tasks which may be assigned: Under the supervision of the Program Manager of Housing Services, the CS and Pas COC ICMSSCI (SCI) is responsible for working effectively with and as part of Step Up’s CS and Pasadena COC ICMS programs to provide high quality, effective care management to members enrolled in these programs. The SCI will provide field‑based services within provider guidelines which includes: outreach and engagement, housing tenancy and sustaining services, housing transition and navigation services, coordination of care, resource linkages, engagement focused on members’ present health goals, concerns, and needs, and working with other professionals and organizations in the community to ensure quality of care for members. The care coordinator may address present mental health behaviors and would coordinate member’s care such as appointment scheduling and referral management, resource linkages, transportation, and/or durable medical equipment requests. The SCI is responsible for collaborating care with the member’s primary care physician (PCP) and to ensure that both members and PCP participate in the development of care plan and to strategize and with an interdisciplinary team and management. Additionally, this position works collaboratively with enrolled members’ families, and other professionals including the designated care team, health professionals and organizations in the community to ensure quality of care for members, seamless transition of care, and facilitation of services is expected. The CSI is to use relationship‑based strategies to engage members in care as well as motivational interviewing or similar empathy‑based strategies. The SCI must have strong organizational skills, computer data entry and other administrative program expertise to submit required documents, visit notes, care plans, demographics, legal documents and other mandatory files into provider portals and Step Up program systems on time and on a daily basis. In addition, the SCI will be able to conduct basic health data and submit health outcomes such as labs, discharge plans and other health related records. The SCI is a mandated reporter and advocates for the health, protection and safety of the enrolled member. Leadership, Administration, Oversight Complete and become proficient in Welligent and Clarity/HMlS to ensure documentation is accurate and in compliance with regulatory requirements and accreditation standards. Ensure the privacy and security of the PHI as outlined in Step Up’s policies and procedures relating to HIPAA compliance including attending annual compliance training. Direct Service and Support Participate in outreach and engagement efforts to enroll referred members in CS. Assist members in navigating the housing market and applying for units. Complete Pasadena COC application packets with members. Housing tenancy and sustaining services. Provide advocacy on behalf of members in the home, the community, and in provider organizations. May transport and attend any appointments to ensure successful completion of and outcomes of each goal. Conducting tenant screenings and housing assessments that identify the member’s preferences and barriers related to successful tenancy. Developing an individualized housing support plan based upon the housing assessment that addresses identified barriers, includes short and long‑term measurable goals for each issue, establishes the member’s approach to meeting the goal. Searching for housing and presenting options to the members. Assisting in securing housing, including the completion of housing applications and securing required documentation (e.g. social security card, birth certificate, prior rental history, identification, and proof of income). Assisting with benefit advocacy, including assistance with obtaining necessary documentation to apply for Social Security and supporting the Social Security/SSl application process. As necessary, identifying and securing available resources to assist with subsidizing rent. Identifying and securing resources to cover expenses such as security deposits, moving costs, adaptive aids, environmental modifications, and other one‑time expenses. Assist members in navigating the healthcare system, helping members successfully participate in their medical and/or behavioral health care by overcoming barriers to care, sharing information on barriers with the PCP to improve care and outcomes. These activities are provided by field‑based outreach. Assisting with members’ transition upon discharge from medical or psychiatric hospitals. By coordinating with hospital discharge planning, being supportive in plan transitions. Collaborating within the hospital to connect with members before they are released can start the relationship building that is important for the care coordinator’s success in member engagement. Navigating housing, routinely revisiting the care plan, and supporting members in attending follow‑up appointments. Play a key role in crisis response teams that provide community‑based alternatives to justice involvement. Deliver information about health and wellness in ways that the community can easily understand and provide information on MCP benefits and services. Transport and attend appointments to ensure successful completion of and outcomes of each health‑related goal or task. Engage with members in a manner that utilizes evidence‑based approaches, such as motivational interviewing, that promotes collaboration between the member and their health. Assist with the coordination of medical and behavioral health access issues with Step Up programs (not limited to CS, FSP, PSH), PCP offices, and specialists. Participate in all formal and informal training courses to gain continue in knowledge on medical conditions including treatments and evidence‑based for treatment always staying within scope. Model the highest ethical behavior in relationship with co‑workers, supervisor, members, provider, and colleagues in the community and within Step Up. Build and maintain a positive working relationship with members and providers including by not limited to communication via in‑person, over the phone, and through digital means, such as email and fax. Participate in staff meetings, trainings, individual supervisions, and other activities as needed or directly by Step Up’s Housing Services team. Any other duties as required to ensure CS and Pas COC ICMS operations are successful Documentation and Data Collection #J-18808-Ljbffr Step Up