Path Program Specialist

Position Title: PATH Program Specialist

Department: Behavioral Health

Supervisor: PATH Program Manager

Supervisory Responsibilities: None

FLSA Status: Non-Exempt

Summary:

The PATH Program Specialist conducts outreach services to those experiencing homelessness with severe and persistent mental illnesses and/or co-occurring substance use disorders. The goal of these outreach services is to help individuals secure safe and stable housing, improve their health, and live a self-directed, purposeful life. The Program Specialist will also assist with applications for and obtaining SSI and SSDI utilizing the SOAR (SSI/SSDI Outreach, Access, and Recovery) model.

Responsible to develop and maintain the PATH presence in the community, including representing PATH at community meetings, responding proactively to all referral sources, and creating an enhanced response to homeless mentally ill persons in both the community and the agency. Responsible to know and work within the parameters of the PATH grant in delivering services and ensuring all client related spending is within the approved grant budget and as prescribed by agency policy.

All employees will exhibit the following behavioral traits:

Integrity and Trust

Individual is widely trusted and can present information and discuss situations in an appropriate and helpful manner, keeps confidences, admits mistakes, does not misrepresent him/herself for personal gain. Is respectful in action and communication with clients, patients, and staff.

Mission Integration

Adheres to the organization’s mission during times of ease or challenge, is dedicated to the expectations and requirements of the mission and vision, acts in line with the values identified by Alluvion Health.

Team Relations

Understands and supports the team approach and integrated model of Alluvion Health. Is seen as a team player, cooperative and supportive of his/her coworkers, practices what he/she preaches. Can be candid with peers and fosters open dialogue. Creates a feeling of belonging on the team and holds self and team accountable to those behaviors.

Essential Job Responsibilities:

1. Conduct assessments to determine eligibility and appropriateness of individuals enrollment into the PATH program, complete intake documentation and coordinate entry and exit of all program participants.
2. Provides intensive care coordination services within a team setting to individuals with severe and persistent mental illness.
3. Provide social work case management and navigation services designed to assist clients and their families obtain stability.
4. Encourage and promote an environment that is strength based to assist clients in meeting their individual goals.
5. Support and closely coordinate primary and/or mental health care with the patient’s primary care provider, mental health providers, specialists, or other community resources.
6. Help eligible participant connect with the available public and private service resources, and follow-up on referrals to encourage participant progress toward stabilization.
7. Perform initial comprehensive case management assessment and develop a plan of intervention that addresses need for housing, services, crisis intervention, and continuity of care planning and coordination.
8. Provide onsite case management services in the areas of independent living skills, cooking groups, house meetings, social events, employment linkage, benefits establishment, and other services as needed to assist in reaching case plan and treatment plan goals.
9. Complete interviews with individuals to gather information to complete SSI/SSDI applications.
10. Gather medical records and other information to complete SSI/SSDI applications.
11. Write SOAR Medical Summary Reports for individual applications.
12. Accompany individuals to appointments at the Social Security Administration;
13. Coordinate visits to medical doctors, psychiatrists, and other specialists to obtain evidence for the application.
14. Assist clients with housing applications, complete supportive and subsidized housing paperwork, survey rental market for affordable housing, and advocate for clients with prospective landlords Advise clients with regards to writing reasonable accommodations, as needed.
15. Identify appropriate permanent housing options for clients, such as subsidized housing Section 8, Shelter Plus Care, VASH, permanent supportive housing, affordable and market rate housing, and other housing opportunities.
16. Maintains compliance standards in accordance with the HRSA compliance policies, HIPAA, HITECH, FTCA and the Code-of-Conduct and reports concerns timely and appropriately.
17. Develop a trusting and helpful relationship with participants without bias regarding their history or circumstance that brought them into the program.
18. Develop a working understanding of Housing First, Trauma Informed Care, Progressive Engagement, and Motivational Interviewing; consistently demonstrates knowledge and understanding of models through all aspects of client care.
19. Maintain client files in an organized, thorough, and timely fashion.
20. Enter required data into the Homeless Management Information System (HMIS).
21. Work to outreach homeless in the community through various efforts and programs and will actively participate in community meetings to work to address homeless issues.
22. Establish and maintain effective working relationships within the agency, with clients and family members, and with involved personnel from other agencies and professions.
23. Performs a variety of other duties as assigned; which may include but are not limited to directing or participating in special projects and events, conducting research, representing Alluvion Health at meetings and conferences, and attending continuing education and training events.

Knowledge, Skills, and Abilities:

Knowledge and understanding of:

• A solid understanding of the recovery process;
• Awareness of mental health and housing issues and resources;
• Community resources;
• Brief, structured intervention techniques (Critical Time Intervention, Motivational Interviewing, Trauma-Informed Care);
• Health information technology and HIPAA/HITECH compliance;
• Electronic Health Records software;
• General office practices;
• Basic computer data entry;
• Cultural sensitivity;
• Safety policies and procedures.

Skills in:

• Strong problem solving and conflict resolution skills with a solution-oriented approach;
• Effective communicator, both orally and written-assertive when necessary;
• Time management and organization;
• Customer service;
• Relationship management;
• Crisis management.

Ability to:

• Follow grant compliance requirements;
• Complete SOAR training within 90 days of hire;
• Conduct appropriate and safe street outreach;
• Must be able to adjust to the environment of the target population including making visits to encampments, shelters, and personal living environments when needed;
• Coordinate transition to ongoing mental health and other services;
• Maintain effective and professional relationships with patients and other members of the care team;
• Screen for common mental health and/or substance use disorders;
• Respond appropriately to an emergency or crisis;
• Manage competing demands, changes in approach or method to best fit the situation;
• Work with people from all walks of life, such as individuals with various social and emotional histories, high risk, unemployed, and homeless, abused and people with mental health conditions;
• Meet established timelines and/or deadlines;
• Learn and utilize the Homeless Management Information System;
• Ability to work in a fast-paced environment and maintain poise under pressure;
• Ability to set appropriate professional boundaries;
• Ability to effectively interact with a diverse clientele and program partners;
• Continuous demonstration of behaviors aligned with our mission and cultural values.

Education/Training/Qualifications:

Education/Training:

OR

Preferred Education and Experience

• Bachelor's Degree in human services, behavioral science, or related field with one year of case management experience;
• Experience in a Federally Qualified Health Center or Healthcare setting;
• experience in intensive case management services to adults with serious disabling mental illness.

Certifications:

Computer:

Language Skills:

Fluent in the English language. Ability to read, analyze, and interpret the most complex documents. Ability to respond effectively to the most sensitive inquiries or complaints.

Physical Requirements:

• Physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions;
• The employee is regularly required to sit and use hands and fingers to provide care to patients and operate computer;
• Frequently is required to reach with hands and arms;
• Must occasionally lift and/or move up to 40 pounds while transporting equipment and supplies;
• Specific vision abilities required by this job include close vision and looking into monitors for extended periods of time and ability to adjust focus which permits the employee to perform computer procedures, and to produce and review a wide variety of documents, correspondence, reports, and related materials in both electronic and printed form;
• Clarity of speech and hearing that permits the employee to communicate well with others;
• Mobility that permits the employee to move about in a variety of building settings; Personal mobility that permits the employee to enter, operate and exit motor vehicles and travel to other clinic sites;
• This position requires travel by foot, car or other means as needed or assigned by the supervisor to effectively support participants enrolled in the program while performing outreach to those experience homelessness and with community partners in the community, and for training needs as scheduled.

Working Conditions:

• Work indoors in a climate-controlled environment 95% of the time.
• OSHA Exposure Category #2. (The normal work routine involves no exposure to blood, body fluids, or tissues, but exposure or potential exposure may be required as a condition of employment.)

Work Hours:

Comments:

This description is intended to describe the essential job functions and the essential requirements for the performance of this job. It is not an exhaustive list of all duties, responsibilities, and requirements of a person so classified. Other functions may be assigned, and management retains the right to add or change the duties at any time.