Job Description

POSITION SUMMARY: Under supervision of Program Management, performs duties by coordinating housing services to an adult population composed of persons with substance-use disorders, SMI, dual-diagnoses and/or referred persons. Provides direct treatment, rehabilitative and supportive services in a community setting to members; works as a team member of a clinical team to assess member needs and wants, participates in the development of individual service plans, acts as a member advocate and liaisons with families and community agencies; provides on-call crisis intervention services, as well as weekend and holiday coverage; serves as the ACT’s specialist on housing and collaborates with other ACT members to provide housing and housing related services for ACT members; performs related duties as required.

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES

The duties listed below are intended only as illustrations of the types of work that may be performed. The omission of specific statements of duties does not exclude them from the position if the work is similar, related or a logical assignment to this classification.

 

  • Provides time-unlimited, community-based services to assigned caseload size of 10:1, ensures intake rate is low to maintain a stable clinical environment for other members on the case load.
  • Actively participates as part of the member’s clinical team.
  • Actively recruits new members who could benefit from ACT.
  • Takes full responsibility for the treatment services for members; coordinates care with ACT team members and other providers to ensure member’s needs are met and the member continues to receive treatment in the community to the greatest extent possible
  • Works with informal support system with or without the member present to provide clinical skills training to increase informal supports (family, landlords, employer etc).
  • Maintains high intensity of services and high-frequency contact with members as needed.
  • Utilizes assertive engagement mechanisms, including street outreach and legal mechanisms (probation/parole, court ordered treatment), when necessary, to re-engage the member in prescribed treatment.
  • Routinely assesses member’s need for ACT services, using explicit criteria to determine need to transfer to less intensive services. Gradually and individually transitions eligible members and ensure continuity of care. Monitors member’s status during transition and reintroduces services as needed to ensure member’s stability in the community.
  • Is responsible for crisis services for assigned members, coordinating hospital admissions and discharge planning.
  • Participates in daily team meeting; provides updates on assigned case load; identifies member’s risks and needs and coordinates care to access needed services. Serves as the subject matter expert in designated role; offering skills training and technical assistance
  • Complies with all program requirements per SAMHSA evidence based practice guidelines, Western Interstate Commission for Higher Education (WICHE), Mercy Maricopa and others as identified by Lifewell Behavioral Wellness.
  • Responsible for transporting members to necessary services, as outlined in their service plan, as needed.
  • Provides all services to members in accordance with established policies and procedures and clinical protocols to provide supportive counseling skill development and other support services as needed.
  • Works with member’s Prescribing Clinician, Nurse, and other members of the clinical team to ensure the timely development and implementation of the individual’s service plan (including all necessary assessments) and their crisis plan.
  • Assists members and families in accessing additional needed services and obtaining entitlements, including identification of funding services.
  • Assumes “primary contact” responsibility for a percentage of team members to: assure maintenance of accurate, thorough, and current documentation in the medical record (in accordance with policies, procedures, and clinical protocols) for those specific individuals; keep weekly member schedule for those individuals updated, and act as first contact for those members and their families.
  • Documents all member events in accordance with policies, procedures, and clinical protocols.
  • Assists the tem in determining appropriate housing resources for individual members
  • Assists members in locating appropriate housing of their choice; provides multiple housing options including integrated housing
  • Provides assistance in accessing affordable, safe/decent housing and permanent housing
  • Ensure member’s on-going tenant rights are upheld; including their right to privacy; including from the ACT team.
  • Works in close collaboration with the Independent Living Specialist and the Rehabilitation Specialist to ensure coordination of services and that member’s housing-related needs are met on an on-going basis.
  • Coordinates with the PCP, Integrated Care Provider or RBHA Care Management Department when developing member’s integrated, individualized service plan, as appropriate.
  • Develops individualized service plans (ISP) that include goals related to member’s medical and behavioral health needs; screens for physical health issues.
  • Ensures clinical interventions recommended by the RBHA care manager/care coordinator are incorporated into the members care.
  • Coordinates transition of member care for PCP services into or out of the clinic setting.
  • Participates in staff meetings, trainings and other activities as required.
  • Performs other duties as required and special projects as assigned.

EDUCATION/LICENSE/CERTIFICATION/EXPERIENCE REQUIREMENTS

  • High School Diploma/GED and three years behavioral health work experience; OR
  • Associate’s degree in behavioral health related field and two years behavioral health work experience; OR
  • Bachelor’s degree in a non-behavioral health related field and one year behavioral health work experience; OR
  • Bachelor’s degree in behavioral health related field
  • One year of related work experience in supported housing
  • Current Arizona Driver License and a current satisfactory 39-month Motor Vehicle Record (MVR)
  • Must be 21 years of age
  • Background Check
  • Minimum typing speed of 25 wpm