Description

Make a meaningful difference where it matters most.

As a contracted partner with Oswego County, Monroe Plan is sourcing experienced Licensed Social Workers who are committed to supporting vulnerable communities through compassionate, person-centered care. Oswego County is currently seeking a Licensed Clinical Case Manager to join their team in the Oswego County area, with a dedicated focus on individuals experiencing homelessness. In this role, you'll go beyond traditional case management - working hands-on to coordinate care, advocate for essential services, and help restore stability and dignity to those most at risk. If you're driven by purpose and ready to be part of a collaborative, mission-led team, we invite you to explore this impactful opportunity.

When you join the Oswego County team, you can expect to reap the intrinsic rewards of serving others while enjoying flexible work arrangements, competitive pay, competitive benefits, and a supportive, inclusive culture!

Candidate must be willing to travel throughout Oswego County on a regular basis.

This is a full time, 40 hour/week position, working primarily in the community. Position requires extensive travel throughout the Oswego County area - mileage reimbursement is provided.
The minimum and maximum annual salary that Oswego County believes in good faith to be accurate for this position at the time of this posting are $60,949 - $78,362. In addition to your salary, Oswego County offers a comprehensive benefits package (all benefits are subject to eligibility requirements) and non-monetary perks. The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.

POSITION SUMMARY
The Licensed Clinician Case Manager will involve community outreach on the streets and coordinating members’ needs before and after their move from street to home, enhancing their daily living skills, providing supportive counseling, and advocating on their behalf when faced with discrimination or healthcare inequities. Member choice, harm reduction, non-coercion, flexibility and person-centered care are essential elements of the SOS program model and should be front and center of the care delivered by the Case Manager. This role will require field-based work, and periodic on call coverage.

Requirements

ESSENTIAL JOB DUTIES/FUNCTIONS

50% Outreach and Engagement

• Persistent and assertive outreach and engagement using strength-based approaches beginning either at known “hang-outs” or “hot spots” within the local communities or during an inpatient hospital admission or emergency department visit.
• Continuously assess the health and social needs of participants through SOS’s conversational and observational assessments and formalized risk assessment tools for those identified as being at high risk.
• Participate in hospital discharge planning meetings to identify the best community resources for returning members.
  Assist with appointment navigation including accompaniment to appointments, transportation training, re-engagement in community care, and addressing barriers to care.
• Review documentation and conduct comprehensive psychosocial assessments to determine the medical, psychiatric, housing, and other social needs of the member within the community.
• Obtain historical and collateral information from multiple sources to support members behavioral and physical health needs.
  Monitor, evaluate, and record participants progress with respect to care plan goals.
• Adheres to Oswego County professional boundaries and protocols.

30% Member/Provider Collaboration

• Work in collaboration with the regional partners to identify available housing and to support participants through the process. Tasks may include applying for housing, prepping for interviews, follow up with housing providers, and assistance with moving in (day of move) and with obtaining housing supplies and learning about the neighborhood.
• Participate in hospital discharge planning meetings to identify the best community resources for returning members.
• Once housed, work with members and their housing providers to resolve clinical issues that are impacting the member’s ability to manage and retain supportive housing.
• Foster relationships with community providers to ensure that members are connected with appropriate services as they transition back into the community.
•  Document a Person-Centered Care Plan, in collaboration with the client and providers

10% Reporting 

• Collect and report data, as required and work with team leader, data analysts, and other SOS staff to use data to inform future care delivery.
• Adhere to program documentation requirements in the Electronic Health Record.
• Provide program information to members and providers, and other organizations as requested to introduce and support program participation.

10% Communication

• Presents in a professional and articulate manner that supports the development of a therapeutic relationship with the member and community providers.
• Provide feedback to providers regarding the progress made and barriers encountered by their members.
• Demonstrates listening skills to support member engagement and development of a person-centered plan of care.

OTHER FUNCTIONS AND RESPONSIBILITIES

• Performs other duties as assigned.
• Attend and participate in team meetings and supervisory sessions.
• Position Limitations:
  Cannot perform any tasks which are governed by license or registration (i.e. cannot answer questions or make recommendations RE diagnosis, medications or treatment).
  Cannot transport active members at any time.
  Cannot perform hands on care. 

MINIMUM REQUIREMENTS/LICENSES/CERTIFICATIONS

• Licensed Social Worker (LMSW, LCSW), Licensed Mental Health Counselor or RN with bachelor’s degree and relevant experience.
• Minimum of 3 to 5 years of work experience in behavioral health and/or criminal justice field.
• Minimum of two years of previous care management experience, working with the Medicaid population.
• Minimum of two years’ experience in providing advocacy services to people who are mentally ill and/or homeless.
• Knowledge of homeless resources, shelter systems and transportation systems.
• Knowledge of counseling principles and methods for mental illness and substance use disorders.
• Knowledge of treatment, rehabilitation, and community support programs as they relate to recipient/residents, families, and staff.
• Ability to develop, evaluate, implement, and modify treatment intervention to meet the needs of individual recipients.
• Ability to prepare accurate and timely reports.
• Demonstrates ability to respect individual/family diversity and maintain confidentiality.
• Demonstrates ability to work as a team member.
• Knowledge of and ability to work collaboratively with providers and county/community health and human services.
• Ability to demonstrate excellent communication skills both oral and written as well as strong interpersonal skills.
• Proven ability to work independently and to manage time appropriately.
• Strong organizational skills.
• Computer literate. Must be able to pass computer documentation competency testing for all software platforms used within the program. This must occur within 3months of initial training and/or 6 months of hire, whichever comes first. 
• Candidates will need a NYS driver’s license and to own or have access to reliable transportation that enables them to fulfill travel requirements of the job including but not limited to, daily visits to members’ homes.