Tri-County Care, a well-established Care Coordination Organization, (CCO) provides care management and coordination services tailored specifically to support people with I/DD and their families. Tri-County Care brings together health care and developmental disability service providers to develop an integrated and comprehensive care plan.The role of the Care Manager is to provide comprehensive care management, in a person-centered manner to meet the needs of the individual and the OPWDD valued outcomes and the state requirements.

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As a core member of a collaborative care team that involves the patient’s primary care provider, a consulting psychiatrist and, when available, other mental health providers in the primary care clinic. Responsible for coordinating and supporting mental health care provided in the primary care clinic. Responsible for coordinating referrals to clinically indicated services outside the primary care clinic (e.g., social services, mental health specialty care, substance abuse treatment). Provide evidence‐based treatments or work with other mental health providers when such treatment is indicated.

AssessmentDevelopment, Implementation and Maintenance of Service Plans (i.e., care planning)Linkages and ReferralsMonitoring and Follow-upService DocumentationDuties of the Medicaid Service Coordinator:The Medicaid Service Coordinator is responsible for:Receiving and processing applications for service coordination for new clients with developmental disabilities.Creating an ISP (Individualized Service Plan) / life style outcomes for each client in their caseload.Developing the individual’s life plan based on their needs and desires, following a Person Centered Planning process.Collaborating with appropriate family members, friends, agency staff, and others in the community who are related to the client’s goals / outcomesDeveloping specific tasks to help realize client outcomes, following up on details and reporting results at regular meetings.Conducting face-to-face contacts, and additional telephone contacts, with clients to ensure planned activities are occurring.Assessing safety and other potential service needs.Listening carefully to what people and families are saying.Recognizing and addressing health and safety issues.Facilitating meetings.Communicating (verbally and in-writing) with individuals, families, advocates and providers.AdvocatingProtecting and upholding the consumer’s rightsEnsuring the individual’s living environment is safe.Developing a network of community based contacts and resources both traditional OPWDD funded and other, in support of the clients in their case load.Linking individual clients to supports and services that enable them to work towards their goals / outcomes.Helping to manage crisis situationsRecord KeepingDocumenting ongoing comprehensive and personal knowledge of the person in order to develop the most effective person-centered quality services.Keeping accurate and current records on service coordination activities and other services provided to the client

• Help you understand how working and earning wages will affect your public benefits• Provide ongoing assistance to help you manage your benefits as you transition into employment or increase your earnings• Provide information on available education, training, and employment services• Help develop and implement PASS Plans and other Work Incentives that assist you to achieve your employment goal• Understand the rules of specific Work Incentives and how they apply to you• Decide whether the Ticket to Work program is right for you• Understand the potential benefits of employment as a person who receives disability benefits from Social Security while dispelling the myths about working• Analyze how work and earnings may impact your Supplemental Security Income (SSI), Social Security Disability Insurance (SSDI), health care, and other public benefits• Understand the services provided by a State Vocational Rehabilitation (VR) agency or an Employment Network (EN), and how they might fit best with your needs• Teach about the work incentives from SSA to beneficiaries and community partners.• Enhance self-sufficiency• Ensure informed choices,• Get rid of fear in pursuing employment• Problem solving and advocacy,• Benefits analysis and advisement/benefits support, planning/benefits management and• Information and referral about other resources available to you in the community.

• Advised clients with drug addiction on program benefits and financial assistance• Created and maintained mailing lists and databases of services for the homeless by updating and providing information on apartment vacancies and housing rights• Maintained and organized various records such as reports and meetings minutes• Planned and delivered numerous life-skill workshops• Maintained liaison with numerous agencies that provide services to our clients• Assisted in recruiting, training and managing employees and volunteers

• Provided excellent customer service to clients while handling an daily average of 200 of inbound customer calls in a courteous and professional manner • Accurately determine requirements by analyzing each customer's situation and resolving issues to ensure client satisfaction• Solved a range of customer inquiries by clarifying, researching, locating and providing desired information to provide timely and effective outcomes, resulting in first call resolution of issues

• Developed a warm, inviting and clean office/reception area to greet guests and escort them to the appropriate party• Managed multi-line phones and provided friendly customer service to all callers while routing them to the correct destination or assisting if applicable