Website Mysti’s Adult and Family Services
Position Overview: The Case/Care Coordinator plays a vital role in ensuring clients’ access to
necessary services and resources, both virtually and in person. This position focuses on coordinating
care among various service providers to meet the mental health and other needs of clients and their
families. The Case/Care Coordinator ensures that clients receive comprehensive, integrated care
tailored to their unique circumstances, utilizing all communication modes for effective service delivery.
Key Responsibilities:
Care Coordination:
● Coordinate care among service providers to support the recovery of clients and their families
● Maintain ongoing communication with treatment providers and ensure collaboration.
● Prevent duplication of services by working closely with other staff and providers.
● Utilize virtual and in-person communication to manage client needs and care coordination.
Client Assessment and Service Planning:
● Conduct thorough assessments of clients’ mental health needs and determine medical necessity.
● Develop, review, and update treatment plans and contribute to the problem list.
● Conduct regular reassessments to ensure services meet clients’ evolving needs.
● Facilitate virtual doctor visits and arrange transportation through CCAH for clients.
Documentation and Record-Keeping:
● Ensure the accuracy and integrity of medical records by adhering to documentation
standards and timelines
● Document services rendered, including initial requests, progress notes, and any
modifications.
● Use Theranest (TN) to document all interactions and services.
● Add files to clients’ case files in Microsoft Teams and into TN under client details.
Client Support and Advocacy:
● Assist clients in accessing necessary services, such as housing, mental health support,
and social services.
● Advocate for clients’ needs within the service system and work to remove barriers to access.
● Provide crisis intervention and support as needed.
● Arrange virtual doctor visits and ensure client attendance at necessary appointments.
Mysti’s Adult and Family Services
Team Collaboration and Communication:
● Engage with multidisciplinary teams to ensure holistic care for clients.
● Participate in virtual and in-person team meetings, sharing relevant information about
clients’ progress and needs.
● Remove staff members from the supporting staff list when they are no longer part of the
treatment team.
● Attend virtual and in-person meetings as required.
Service Referrals and Follow-Ups:
• Refer clients to appropriate community resources and follow up to ensure service connection.
● Collaborate with external agencies to secure additional services for clients.
● Complete applications, and ROI referrals, and ensure timely submission using
virtual and in-person methods.
Client Caseload Management:
● Manage ECM and Community Support caseloads.
● Work on up to 6 cases per day, including finding resources for clients, holding case
conferences, and filling out applications on their behalf.
● Align services with Monterey County and State of California public benefits for
clients who qualify for ECM and Community Supports, including Medi-Cal, CalFresh,
General Assistance, and housing assistance programs.
● Input notes into Theranest (TN) with all applicable service types when clients are
enrolled in programs provided through our contract with CCAH.
Qualifications:
● Bachelor’s degree in social work, psychology, or a related field (master’s preferred).
● Experience in case management or a related role in a behavioral health setting.
● Strong understanding of trauma-informed care and recovery-oriented services.
● Excellent communication and organizational skills.
● Ability to work collaboratively with multidisciplinary teams.
● Proficiency in electronic health record systems.
● Effective use of virtual communication tools for client management and team collaboration
Core Values:
● Welcoming: Prioritize welcoming all clients, especially those with the greatest challenges.
● Hopeful: Inspire hope for a meaningful and happy life.
● Person and Family Driven: Provide services in partnership with clients to achieve
their life goals.
● Strength-based: Recognize and build on clients’ strengths.
● Trauma-informed: Commit to never contributing to re-traumatization.
● Cultural Humility: Learn from clients to fit services within their cultural contexts.
● Integrated Care: Provide comprehensive care addressing mental health, substance use,
physical health, and social needs
