Integrated Health Home Habilitation Care Coordinator

Job Title: Adult IHH Habilitation Care Coordinator

Reports to: IHH Team Lead

Job Purpose: This position serves as an integral member of the interdisciplinary team for the Integrated Health Home Initiative. The Adult IHH Habilitation Care Coordinator’s primary responsibility is to respond to the needs of adults with a Serious Mental Illness (SMI) who qualify for Habilitation services. This position will provide the initial authorization of Habilitation services using a patient-centered approach across medical, behavioral and community systems.

Essential Duties and Responsibilities:

• Closely monitor and provide Care Coordination for patients who are hospitalized, at-risk of hospitalization, discharging from a hospital, or who are experiencing care transitions.

• Provide Care Coordination services that align with the State Plan Amendment’s ICM requirements and the IHH’s six core services (Comprehensive Care Management, Health Promotion, Referral to Community and Social Support Services, Comprehensive Transitional Care and Individual/Family Support).

• Establish and maintain routine collaborative meetings with system partners to promote partnership between Managed Care Organizations, Iowa Medicaid Enterprise (IME) and the system partner toward achieving benchmark standards and improving patient care.

• Uses available data, such as exams/assessments scores, participant evaluations, and service observations to identify health and wellness needs to develop care coordination plans, social histories, and Habilitation assessments.

• Participate in Quality Improvement activities related to improved patient outcomes, including data collection, tracking, and analysis.

• Maintain an active workload in accordance with Managed Care quality standards and quality management plan protocols.

• Conduct in-depth interviews/assessments and use specialized knowledge to gather complicated information from patients to be enrolled in habilitation services through the IHH program.

• Synthesize information from treatment records, risk stratification, and other sources to assess program enrollees. Apply evidence-based clinical guidelines for behavioral and physical health issues, in addition, knowledge of care coordination techniques in assessing the needs of recipients and determining interventions to address those gaps.

• Demonstrate excellent customer service and collaborate with physicians, consumers, members, visitors, staff, and the health care community.

• Collaborate with Integrated Health Home Team and treating providers in developing and implementing care coordination plan to address treatment barriers for each low to moderate risk patient. Refer high-risk patients to Nurse Care Manager.

• Record and maintain documentation in Practice Management System and Health Information Technology. Maintain patient confidence and protect operations by keeping information confidential.

• Demonstrate flexibility in job duties and schedule in order to aid in better serving the organization, the consumers, and to assist reaching benchmark standards set forth by Managed Care Organizations. Allow for flexibility in scheduling to accommodate crisis situations for patients.

• Attend regularly scheduled meetings and training sessions to enhance team performance.

• Adhere to all policies and procedures set forth by Siouxland Mental Health, IME and Managed Care Organizations. Complete all necessary paperwork for insurance and billing. Abide by all deadlines set forth by Siouxland Mental Health, IME and Managed Care Organizations.
• Uses available data, such as exams/assessments scores, participant evaluations, and service observations to identify health and wellness needs to develop habilitation assessments and care coordination plans.

• Participates in various workgroup and committee activities to support departmental and organizational efforts to improve the quality of services throughout our systems of care.

• Participate in an interdisciplinary approach to client care, complete internal program referrals, and demonstrate a high degree of team-based treatment.

Additional Duties and Responsibilities:

• Accomplish all tasks as appropriately assigned or requested.

Competencies:

• Social Skills—the individual professionally interacts with members and models appropriate behaviors.
• Problem solving—the individual identifies and resolves problems in a timely manner and gathers and analyzes information skillfully.
• Oral communication—the individual speaks clearly and persuasively in positive or negative situations, demonstrates group presentation skills and conducts productive meetings.
• Written communication—the individual edits work for spelling and grammar, presents data effectively and is able to read and interpret written information.
• Leadership—the individual inspires and motivates others to perform well, accepts feedback from others.
• Quality management—the individual looks for ways to improve and promote quality and demonstrates accuracy and thoroughness.
• Judgment—the individual displays willingness to make decisions, exhibits sound, accurate, and ethical judgment and makes timely decisions.
• Planning/organizing—the individual prioritizes and plans work activities, uses time efficiently and develops realistic action plans.
• Safety and security—the individual observes safety and security procedures and uses equipment and materials properly.
• Interpersonal skills—the individual maintains confidentiality, remains open to others’ ideas and exhibits willingness to try new things.

Experience and Education:

Required:

• Bachelor’s Degree in a human service related field.
• Knowledge of, and experience in working with individuals with mental illness and/or disabilities.

Preferred:

• Knowledge of utilization management procedures, mental health and substance abuse community resources and providers.

Job Type: Full-time

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Disability insurance
• Employee assistance program
• Flexible schedule
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Paid training
• Professional development assistance
• Retirement plan
• Vision insurance

Schedule:

• Monday to Friday
• No weekends

Work Location: In person