Integrated Services of Appalachian Ohio

Care Coordinator

• Create, plan, and organize teams defined by families
• Develop, lead, and facilitate child and family team meetings
• Provide care coordination in family homes, communities, or preferred locations
• Partner with youth, families, natural supports, and service providers to identify care coordination needs and services
• Lead teams in identifying needs, goals, and action steps
• Ensure youth and families have voice and choice in coordinated care and services
• Maintain documentation required to access and maintain OhioRISE benefits
• Meet ISBH OhioRISE quality and fidelity standards
• Maintain knowledge of community resources
• Attend mandatory in-person and virtual trainings and supervision, requiring travel
• Complete assigned trainings and maintain required certifications
• Follow confidentiality, professionalism, incident-reporting, HIPAA, mandated-reporting, and ethical requirements
• Use databases and Electronic Health Record systems for client documentation
• Travel within the assigned service area
• Perform other assigned duties

• Create, plan, organize, lead, and facilitate child and family team meetings
• Provide care coordination in the family’s home, community, or preferred location
• Partner with youth, families, natural supports, and service providers to identify care coordination needs and services
• Support youth at home, in school, and in their communities
• Help keep families together and reduce hospitalizations
• Ensure youth and families have voice and choice in coordinated care and services
• Maintain documentation to access and maintain OhioRISE benefits
• Meet ISBH OhioRISE quality and fidelity requirements
• Maintain knowledge of community resources
• Attend mandatory in-person and virtual trainings and supervision, requiring travel
• Complete assigned trainings and maintain required certifications
• Follow confidentiality, professionalism, incident-reporting, HIPAA, mandated-reporting, and ethical requirements
• Use databases and Electronic Health Record systems for accurate client documentation
• Travel within the assigned service area
• Perform other duties as assigned

• Create, plan, organize, lead, and facilitate child and family team meetings
• Provide care coordination in families' homes, communities, or preferred locations
• Partner with young people, families, natural supports, and service providers to identify care coordination needs and services
• Support youth at home, in school, and in their communities
• Help keep families together and reduce hospitalizations
• Ensure youth and families have voice and choice in coordinated care and services
• Maintain documentation to access and maintain OhioRISE benefits
• Meet ISBH OhioRISE quality and fidelity requirements
• Maintain knowledge of community resources
• Attend mandatory in-person and virtual trainings and supervision, requiring travel
• Complete assigned trainings and maintain required certifications
• Follow confidentiality, professionalism, incident reporting, HIPAA, mandated reporting, and ethical requirements
• Use databases and Electronic Health Record systems for client documentation
• Travel within the assigned service area
• Perform other duties as assigned

• Create, plan, and organize a team defined by the family
• Develop, lead, and facilitate child and family team meetings
• Provide care coordination in the family's home, community, or preferred location
• Partner with youth, families, natural supports, and service providers to identify care coordination needs and services
• Ensure youth and families have voice and choice in coordinated care and services
• Maintain documentation to access and maintain OhioRISE benefits
• Meet ISBH OhioRISE quality and fidelity requirements
• Maintain knowledge of community resources
• Attend required trainings and supervisions, including travel
• Complete assigned trainings and maintain required certifications
• Follow confidentiality, professionalism, incident reporting, HIPAA, mandated reporting, and ethical requirements
• Use databases and Electronic Health Record systems for client documentation
• Travel within the assigned service area
• Perform other assigned duties

• Create, plan, organize, lead, and facilitate child and family team meetings
• Provide care coordination in families' homes, communities, or preferred locations
• Partner with youth, families, natural supports, and service providers to identify needs and services
• Ensure youth and families have voice and choice in coordinated care and services
• Maintain documentation to access and maintain OhioRISE benefits
• Meet ISBH OhioRISE quality and fidelity requirements
• Acquire and maintain knowledge of community resources
• Attend mandatory in-person and virtual trainings and supervision, with required travel
• Complete assigned trainings and maintain required certifications
• Follow ISBH policies and procedures regarding confidentiality, professionalism, and incident reporting
• Use databases and Electronic Health Record systems for accurate client documentation
• Maintain compliance with HIPAA, mandated reporting requirements, and professional ethical guidelines
• Travel within the assigned service area
• Perform other duties as assigned

• Assist with immediate care coordination needs of youth hospitalized due to a behavioral health condition and enrolled in the OhioRISE program
• Support families with the hospital discharge process
• Educate families and community partners about the OhioRISE program
• Make referrals for follow-up care and services
• Attend in-person and virtual meetings to complete engagement milestones, including crisis safety plans, assessments, care plans, and scheduling and facilitating Child and Family Team meetings
• Ensure a warm handoff to the youth’s ongoing care coordinator
• Identify care coordination needs and services with families in line with service delivery standards and program outcomes
• Work with families to define cultural factors influencing strengths, functioning, and family interaction styles
• Identify strengths of children, youth, and families for care coordination engagement and healthy outcomes
• Coordinate family-based services in homes, schools, and communities
• Ensure care-plan services are appropriate, least restrictive, and meet safety and treatment needs
• Build positive relationships with children, youth, and families in coordination with child and family teams
• Develop collaborative partnerships with community resources
• Maintain documentation and participate in program evaluation
• Attend team and program planning meetings and cross-systems training
• Acquire knowledge of community resources
• Remain current with training requirements, including High Fidelity Wraparound, MI, and Cultural Humility
• Perform other duties as assigned

Engagement Care Coordinator

• Create, plan, and organize teams defined by families for youth ages 0–20 with complex behavioral health and/or substance use needs
• Develop, lead, and facilitate child and family team meetings
• Provide care coordination in families’ homes, communities, or preferred locations
• Partner with youth, families, natural supports, and service providers to identify care coordination needs and services
• Ensure youth and families have voice and choice in coordinated care and services
• Maintain documentation required to access and maintain OhioRISE benefits
• Meet ISBH OhioRISE quality and fidelity requirements
• Maintain knowledge of community resources
• Attend mandatory in-person and virtual trainings and supervision, including required travel
• Complete assigned trainings and maintain required certifications
• Follow confidentiality, professionalism, incident reporting, HIPAA, mandated reporting, and ethical requirements
• Use databases and Electronic Health Record systems for client documentation
• Travel within the assigned service area

• Create, plan, and organize teams defined by families
• Develop, lead, and facilitate child and family team meetings
• Provide care coordination in families' homes, communities, or preferred locations
• Partner with youth, families, natural supports, and service providers to identify care coordination needs and services
• Support youth at home, in school, and in their communities
• Lead teams in identifying needs, goals, and action steps
• Ensure youth and families have voice and choice in coordinated care and services
• Maintain documentation required to access and maintain OhioRISE benefits
• Meet ISBH OhioRISE quality and fidelity standards
• Maintain knowledge of community resources
• Attend mandatory in-person and virtual trainings and supervision, including travel
• Complete assigned training and maintain required certifications
• Follow confidentiality, professionalism, incident-reporting, HIPAA, mandated-reporting, and ethical requirements
• Use databases and Electronic Health Record systems for accurate client documentation
• Travel within the assigned service area
• Perform other duties as assigned

• Create, plan, organize, lead, and facilitate child and family team meetings
• Provide care coordination in families' homes, communities, or preferred locations
• Partner with youth, families, natural supports, and service providers to identify care coordination needs and services
• Support youth at home, in school, and in their communities
• Help keep families together and reduce hospitalizations
• Ensure youth and families have voice and choice in coordinated care and services
• Maintain documentation required to access and maintain OhioRISE benefits
• Meet ISBH OhioRISE quality and fidelity standards
• Maintain knowledge of community resources
• Attend mandatory trainings and supervisions, including travel
• Complete assigned trainings and maintain required certifications
• Follow confidentiality, professionalism, and incident-reporting policies
• Use databases and Electronic Health Record systems for client documentation
• Maintain HIPAA, mandated-reporting, and professional ethical compliance
• Travel within the assigned service area
• Perform other duties as assigned

• Create, plan, organize, lead, and facilitate child and family team meetings
• Provide care coordination in families' homes, communities, or preferred locations
• Support youth at home, in school, and in their communities
• Partner with youth, families, natural supports, social service providers, and community partners
• Identify care coordination needs, goals, and action steps
• Ensure youth and families have voice and choice in coordinated care and services
• Maintain documentation required to access and maintain OhioRISE benefits
• Meet ISBH OhioRISE quality and fidelity requirements
• Maintain knowledge of community resources
• Attend required trainings and supervision, including travel
• Complete assigned trainings and maintain required certifications
• Follow confidentiality, professionalism, incident reporting, HIPAA, mandated reporting, and ethical requirements
• Use databases and Electronic Health Record systems for client documentation
• Travel within the assigned service area
• Perform other duties as assigned

• Create, plan, and organize teams as defined by families
• Develop, lead, and facilitate child and family team meetings
• Provide care coordination in families' homes, communities, or preferred locations
• Partner with youth, families, natural supports, and service providers to identify care coordination needs and services
• Ensure youth and families have voice and choice in coordinated care and services
• Maintain documentation to access and maintain OhioRISE benefits
• Meet ISBH OhioRISE quality and fidelity requirements
• Maintain knowledge of community resources
• Attend mandatory in-person and virtual trainings and supervision, requiring travel
• Complete assigned trainings and maintain required certifications
• Follow ISBH policies and procedures regarding confidentiality, professionalism, and incident reporting
• Use databases and Electronic Health Record systems for accurate client documentation
• Maintain compliance with HIPAA, mandated reporting requirements, and professional ethical guidelines
• Travel within the assigned service area
• Perform other assigned duties

• Assist with immediate care coordination needs of youth hospitalized due to behavioral health conditions and enrolled in the OhioRISE program
• Support families with the hospital discharge process
• Educate families and community partners about the OhioRISE program
• Make referrals for follow-up care and services
• Attend in-person and virtual meetings to complete engagement milestones
• Complete crisis safety plans, assessments, and care plans
• Schedule and facilitate Child and Family team meetings until warm handoff to the youth’s ongoing care coordinator
• Identify care coordination needs and services with families in line with service delivery standards and program outcomes
• Work with families to define cultural factors influencing strengths, functioning, and interaction styles
• Identify strengths of children, youth, and families for care coordination engagement and healthy outcomes
• Coordinate family-based services in homes, schools, and communities
• Ensure care-plan services are appropriate, least restrictive, and meet safety and treatment needs
• Build positive relationships with children, youth, and families in coordination with child and family teams
• Develop partnerships with community resources to meet diverse youth and family needs
• Maintain documentation and participate in program evaluation
• Attend team and program planning meetings and cross-systems training
• Maintain required training, including High Fidelity Wraparound, MI, and Cultural Humility
• Perform other duties as assigned

• Create, plan, and organize teams defined by families
• Develop, lead, and facilitate child and family team meetings
• Provide care coordination in families' homes, communities, or preferred locations
• Partner with youth, families, natural supports, and service providers to identify care coordination needs and services
• Support youth at home, in school, and in their communities
• Help keep families together and reduce hospitalizations
• Ensure youth and families have voice and choice in coordinated care and services
• Maintain documentation to access and maintain OhioRISE benefits
• Meet ISBH OhioRISE quality and fidelity requirements
• Maintain knowledge of community resources
• Attend mandatory in-person and virtual trainings and supervisions, requiring travel
• Complete assigned trainings and maintain required certifications
• Follow confidentiality, professionalism, and incident-reporting policies
• Use databases and Electronic Health Record systems for client documentation
• Maintain HIPAA, mandated-reporting, and professional ethical compliance
• Travel within the assigned service area
• Perform other assigned duties

• Create, plan, and organize teams defined by families
• Develop, lead, and facilitate child and family team meetings
• Support youth at home, in school, and in their communities
• Coordinate care within the family’s home, community, or preferred location
• Partner with youth, families, natural supports, and service providers to identify care coordination needs and services
• Lead teams in identifying needs, goals, and action steps
• Ensure youth and families have voice and choice in coordinated care and services
• Maintain documentation to access and maintain OhioRISE benefits
• Meet ISBH OhioRISE quality and fidelity requirements
• Maintain knowledge of community resources
• Attend required trainings and supervisions, including travel
• Complete assigned trainings and maintain certifications
• Follow confidentiality, professionalism, incident-reporting, HIPAA, mandated-reporting, and ethical requirements
• Use databases and Electronic Health Record systems for client documentation
• Travel within the assigned service area
• Perform other assigned duties

• Create, plan, organize, lead, and facilitate child and family team meetings
• Provide care coordination in families' homes, communities, or preferred locations
• Partner with youth, families, natural supports, and service providers to identify care coordination needs and services
• Support youth at home, in school, and in their communities
• Help keep families together and reduce hospitalizations
• Ensure youth and families have voice and choice in coordinated care and services
• Maintain documentation required to access and maintain OhioRISE benefits
• Meet ISBH OhioRISE quality and fidelity requirements
• Maintain knowledge of community resources
• Attend mandatory in-person and virtual trainings and supervision, including required travel
• Complete assigned trainings and maintain required certifications
• Follow confidentiality, professionalism, incident reporting, HIPAA, mandated reporting, and ethical requirements
• Use databases and Electronic Health Record systems for accurate client documentation
• Travel within the assigned service area
• Perform other duties as assigned