The Care Navigator assists agency clinical staff in providing person-centered, trauma-informed, wellness, health, and recovery-oriented care management services to individuals of all ages. Works collaboratively across all departments at the Center and serves as a liaison with outside agencies. Care Navigators are involved in evaluating clients’ needs and coordinating various services/appointments to help them gain a higher level of functioning and independence.
Essential Functions
- Assessing client needs: mental health/substance use/physical health/housing/finance etc. and identify the client’s strengths and challenges.
- Provides brief support and psychoeducation to clients/families.
- Completes necessary documentation in electronic health record (treatment plans, PQH-9, closings, etc.)
- Track treatment response and monitor clients (in person or by telephone) for changes in clinical symptoms and treatment side effects or complications.
- Support clinical care through monitoring treatment adherence, reporting on client feedback related to side effects, effectiveness of treatment etc. Also, develops crisis plans if needed.
- Participate in regularly scheduled (usually weekly) caseload consultation with the treatment team. Consultations will focus on clients new to the caseload and those who are not improving as expected under the current treatment plan. Case reviews may be conducted by telephone, video, or in person.
- Facilitate treatment plan discussions for clients who are not improving as expected in consultation with the treatment team and who may need more intensive or more specialized care.
- Facilitate referrals for clinically indicated services outside of the Center (e.g., social services such as housing assistance, vocational rehabilitation, mental health specialty care, substance abuse treatment, medical specialty care).
- Develop and complete relapse prevention self-management plan with clients who have achieved their treatment goals and are soon to be discharged from the caseload.
- Communicates pertinent information regarding individuals served to agency prescribers, nurses, therapists and staff. Also communicates with external providers to assure coordination of care including warm hand-offs, driving clients to appointment, etc.
- Documents care management activities in the electronic health record (EHR) in a timely and effective manner and in accordance with agency/state/accrediting body standards
- Tracks essential data and performance improvement measures and provide regular reports to the Care Navigator Coordinator.
- Performs other related duties as assigned including cross-departmental coverage as needed.
Qualifications
Essential
- Bachelor’s degree or associate degree with experience in human service field of study.
- Valid NJ Driver’s License.
- Computer proficient with ability to work in an EHR.
- Ability to comprehend, express and exchange information over the phone, in person, in writing or through other communication or electronic devices.
Preferred
- Minimum of 2 years’ experience in a mental health or healthcare setting.
- Understanding of symptoms of major psychiatric diagnosis across the lifespan.
- Bilingual (Spanish/English) and experience with/sensitivity to culturally diverse populations.
