Pre-Release Care Coordinator (51378)

POSITION SUMMARY:
The person in this position will be responsible for conducting pre-release care coordination for justice-involved individuals eligible for Enhanced Care Management (ECM) services under the CalAIM Justice-Involved Initiative. The Justice-Involved Pre-Release Care Coordinator will conduct in-reach activities within correctional facilities and coordinate care planning prior to release to ensure successful transition into community-based services.

The Care Coordinator will work as part of a multi-disciplinary care team including correctional health staff, behavioral health providers, managed care plans, and community providers to ensure continuity of care upon release. Responsibilities include outreach, eligibility verification, assessment, development of individualized care plans, and coordination of medical, behavioral health, housing, and social services to address the clinical and non-clinical needs of justice-involved Members. Essential Job Functions are below.

ESSENTIAL JOB FUNCTIONS:
• Conduct in-reach within correctional facilities to identify and engage justice-involved individuals eligible for Enhanced Care Management services prior to release.
• Receive and review referrals from Medi-Cal Managed Care Plans, correctional partners, and community agencies and determine eligibility for program participation.
• Conduct intake screenings and develop individualized pre-release care plans in collaboration with the Member and multidisciplinary care team.
• Coordinate pre-release discharge planning, including linkage to medical care, behavioral health services, substance use treatment, housing resources, and other community-based services.
• Collaborate with correctional health staff, managed care plans, probation/parole, and community providers to ensure continuity of care upon release.
• Assist Members with appointment scheduling, and other reentry needs.
• Manage an assigned caseload of Members, including maintaining accurate records and tracking program data.
• Provide service coordination and referrals to medical, behavioral health, housing, and community-based providers, including follow-up to ensure service connection.
• Maintain regular communication with Members and care team partners to support engagement and continuity of care.
• Complete timely documentation, reports, and data entry in WestCare’s Clinical Data System and other required reporting systems.
• Provide services in a culturally responsive and linguistically appropriate manner.
• Embrace and embody the mission, vision, guiding principles, clinical vision, and goals of WestCare Foundation.
• Perform other duties as assigned.