Clinical Case Manager

Description

Purpose: (General description and summary)

ICM Clinical Case Manager provides community-based interventions designed to stabilize and support high-need individuals on the Intensive Case Management (ICM) team in Washington and parts Multnomah Counties with an assertive engagement approach. The case manager works as part of the Integrated Dual Disorders ICM team to implement, monitor, and document services to individuals enrolled on this team from a trauma informed, DEI focused lens, connection to resources and peer supports, and demonstrate strong advocacy skills on participant’s behalf. The ICM Clinical Case Manager will work in tandem with the Mental Health Clinician to allow for increased contact and crisis response. Case Managers follow procedures, outcome goals, and reporting requirements as outlined by New Narrative’s contract with Washington and Multnomah Counties. Services are community based whenever possible with at least two-thirds of the case manager’s time spent out of the office and making use of natural community supports such as family, friends, landlords, employers etc.

Environment:

This is primarily a community-based outreach position where 60-75% if your time will be in the community in a mixture of direct care, coordination, skills training, transportation, or travel. You will be provided with technology to support community-based work. Due to the nature of the work, you will be exposed to various weather conditions and expected to maintain outreaching unless directed to otherwise by your supervisor. There is an office space at a clinic for administrative tasks and team meetings. This is a direct care role that requires in person contact with participants.

Accountabilities: (Responsibilities of the job)

Case Management

ICM Clinical Case Manager with work collaboratively with Mental Health Clinician and participant to create and implement the participant’s individual service plan. The ICM team provides comprehensive wrap around services through inter-disciplinary care to assist individuals to meet their basic needs, promote safety, accomplish goals, as outlined in the collaborative treatment plan, and attain the highest level of independence possible. These services included coordination of care, skills training, case management and connection to local benefits, coordination with medical providers (and other providers as needed) and assisting participants in meeting basic IADL needs. The number of contacts are 2-3x weekly and community based in combination with coordination with providers and integrated team.

• Assist participant in connecting to resources and maintaining resources needed to achieve goals set in the individual service and support plan, including: SSI/SSDI, SNAP, vital documents, ID, etc.
• Advocate for and with participant.
• Provide transportation using company vehicle as needed to/from appointments to ensure connection and access to resources, as well as skills training opportunities in the community, etc.
• Monitor, coordinate, and document all agency services.
• Develop relationships with providers and stakeholders to facilitate service provision.
• Have regular, frequent contact with consumers and identified providers/supports.
• Monitor medication distribution, assist with prescriber visits.
• Coordinate with external providers and natural supports for participant’s wellness, including: PCP/medical, money management services, ENCC, FD, prescribers, other community providers, and intervene as necessary with landlords and other community stakeholders to encourage housing stability.
• Connect participants to cultural resources as applicable.
• Regular documented coordination with integrated team
  
  

Skills Training

• In collaboration with participants, identifying functional barriers as well as other skills training needs (ie. ADLs, iADLs), creating an agreed upon plan to achieve goals.
• Addressing other identified skills training needs in collaboration with other providers (ie. Community integration, interpersonal effectiveness, budgeting, medication management, regulation/coping, safety, etc.)
• Collaborates closely with Mental Health Clinicians to incorporate appropriate interventions into each participant’s service plan.
• Utilize MI, assertive engagement, and other therapeutic modalities to skill build around recovery and symptom management strategies.
  
  

Crisis Prevention and Intervention

• Work proactively with individuals to avoid use of crisis services and respond to crisis situations and utilize critical thinking skills to manage and prioritize needs.
• Situational awareness
• Utilize de-escalation practices and connect participants to emergency services as needed.
• Use trauma informed practices and DEI awareness and sensitivity.
• Coordinate respite referrals and entries as well as oversee respite stay.
• Complete all required documentation, including IRs, within 24 hours of crisis/incident.
• Monitor hospital contact through case management, care conferences, with heavy involvement in transition planning as well as visitation with participant while hospitalized.
• Minimize the number of days spent using crisis/respite services intensive by remaining closely involved in transition planning and proactive approach to crisis prevention.
  
  

Administration

• Document all participant contact within 72 hours of service delivery in Electronic Health Record.
• Utilize feedback informed treatment to provide outcome-informed care.
• Ensure ROIs and consents are up to date and obtain new paperwork as indicated.
• Document all meaningful interactions with participants according to policy and Oregon Administrative Rules
• Utilize outcomes based care tools and review regularly
• Participate in one-on-one supervision bi-weekly to review interventions, documentation, and professional goal setting
• Attend and positively participate in required meetings, including weekly staff meetings and care coordination meetings with LMPs and other involved providers.
  
  

Team Configuration and Meetings:

• The team will coordinate daily and meets for 1-2 hour team meetings to staff complex cases and plan services. Meetings are clinically focused and function as group supervision.
• New Narrative ICM Clinical Case Manager will report to the ICM Team lead and Intensive Services Program Manager.
  
  

Other General Expectations:

• Attend and positively participate in required meetings.
• Have personal and reliable transportation.
• Adhere to Confidentiality, Professional Ethics, and Dual Relationships per policy and Administrative Rule
• Uphold values and mission of New Narrative in all interactions.
• Pursue ongoing development of skills and competencies with emphasis on CADC competencies. A minimum of 16 hours of on-going education, 12 of which must be in the area of mental health/dual recovery and four hours in cultural competency.
• Follow all corporate polices, procedures, and protocols.
• Maintain current Oregon Driver’s License.
• Follow through on all directives and instructions.
• Maintain security of all corporate interests.
• Maintain CPR and First Aid Certificate.
• Maintain QMHA certification