Legacy Community Health Services
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Youth Reentry Case Manager
at Legacy Community Health Services
Legacy Community Health is a premium, Federally Qualified Health Center (FQHC) that provides comprehensive care to community members regardless of their ability to pay. Our goal is to treat the entire patient while improving their overall wellness and quality of life, in addition to providing free pregnancy tests, HIV/AIDS screening. At Legacy, we empower patients to lead better lives by promoting healthy behaviors and offering resources such as literacy classes, family planning services, and nutrition and weight management information.
Our roots began in 1981 as the Montrose Clinic, with specialization in HIV education, testing, and treatment. Since then, the agency has expanded to 10 clinics in Houston, one in Baytown, two in Beaumont, and one in Deer Park with extensive services that include: Adult primary care, HIV/AIDS care, pediatrics, OB/GYN and maternity, dental, vision and behavioral health. We also service students within KIPP and YES Prep schools. Legacy is committed to driving healthy change in our communities.
The Youth Reentry Coordinator provides intensive case management services and coordination services to juveniles released from Harris County Juvenile Detention Center to help improve their connection into care at Legacy for behavioral health and medical needs. Responsibilities include but are not limited to: case management, linkages to care, patient advocacy, and psychological and social support.
- Screen individuals referred by the HCJDC Discharge Planner for social service needs and willingness to be linked in to care.
- Serve as the primary point of contact between Legacy Community Health and HCJDC staff for referred patients, including staffing cases with HCJDC Discharge Planner, Psychiatrist, and Juvenile Probation Officer.
- Assess each referred client’s medical and psychosocial history and current service needs while assisting with reentry and integration post-release.
- Meet with referred clients at probation appointments, and during home visits while linking them in to care.
- Provide information, referrals, and assistance with linkage to medical, psychosocial, and basic needs services as needed to assist with reentry for the youth and family members.
- Advocate on behalf of clients and families to decrease service gaps and remove barriers to services.
- Connect with relevant Legacy staff and providers to assist with system navigation, including Eligibility, Pediatrics, Behavioral Health, etc.
- Create care plans for referred patients/families to provide guidance and assistance with meeting care goals.
- Provide crisis counseling and risk reduction counseling as needed for referred youth and families.
- Monitor the efficacy and quality of services through periodic re-evaluation with peers and supervisor.
- Document service provided in EHRS client record within 72 hours.
- Participates in Legacy’s Performance Improvement and Quality Assurance Program.
- Demonstrates respect and regard for the dignity of all patients, families, visitors and fellow employees to insure a professional, responsible and courteous environment.
- Promotes effective working relations and works effectively as part of a team to facilitate the department’s ability to meet its goals and objectives.
- Attend required training and ongoing education offered by the agency.
- Including but not limited to safety trainings and education sessions on Universal Precautions.
- Must be able to travel between Legacy locations, to HCJDC, and patient homes as needed.
- Maintains work area and equipment in condition required by Legacy standards.
- Works within the context of a primary care medical home, applying a team based approach to care while working in partnership with patients/families to promote: timely access to care, understanding of patient care that is culturally sensitive and language appropriate, continuity of care, and the improvement of the whole-person through the teaching of appropriate self-management skills.
Education & Training Requirements
- Bilingual (English/Spanish) is preferred. If the employee is bilingual then they must have written and verbal fluency in English and Spanish.
- A High School Diploma / GED is required, BSW is strongly preferred. Other candidates with a 4 year college degree in social sciences or candidates actively working towards a degree in social sciences will be considered.
- Have at least 2 years of experience working with children and youth, assessing the psychosocial and health needs of clients and their families and making community referrals for these populations. This experience must include the following: paid work experience; or supervised educational social work or registered nurse internship/practicum experience.
- 9 Holiday + 1 Floating Holiday
- 403b Retirement Plan
- Medical / Vision / Dental (if eligible)
Equal Opportunity Employer, including disabled and veterans.
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