Field Based Clinical Care Coordinator - Clark County, IN

Responsibilities

• Manage a panel of older adult members with complex medical and behavioral health needs.
• Conduct comprehensive assessments covering medical, behavioral, functional, cultural, and socioeconomic factors.
• Develop and implement personalized, person-centered care plans with goals and interventions.
• Collaborate with care teams, providers, and community resources to execute care plans.
• Provide referrals and linkage to internal and external support services, including housing, pharmacy, and behavioral health providers.
• Engage members face-to-face or telephonically to assess needs and support health outcomes.
• Coordinate with internal teams and community partners to ensure comprehensive care.

Qualifications & Skills

• Master's Degree in Social Work or a Bachelor's with relevant experience in case management and supporting older adults.
• At least 2 years of experience in long-term support services and working with behavioral health and SDoH.
• Proficiency in MS Office and strong communication skills.
• Ability to travel within the designated area and reliable transportation.
• Physical ability to visit multiple locations and work both in-office and in the field.