Case Manager - MHA/PASRR

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Position Summary

The MI PASRR Service Coordinator, QMHP provides specialized services and service coordination for individuals with  Mental Illness (MI), Intellectual Disabilities (ID), Developmental Disabilities (DD) or Related Conditions (RC) to ensure they are placed appropriately, whether in the community or in a Nursing Facility: and to ensure they receive the services that they require for their MI or IDD/DD. The PASRR Service Coordinator offers specialized services to help the individual achieve and maintain community reintegration skills. The position provides or arranges for provision of educational or informational activities addressing community living options for individuals transitioning from nursing facilities and their families. The PASRR SC, QMHP will complete case management assessment on clients entering caseload that live in Brazoria County with an MI diagnosis and develop appropriate treatment/service plans with clients as the means for implementing appropriate services and developing effective rapport with clients.   The PASRR SC, QMHP will provide on-going case management functions in accordance with the problems, needs, and the strategies identified within the service plan in order to help the clients to achieve goals and objectives and provide face to face assessments with the clients on a biannual basis. The PASRR SC, QMHP may provide coverage to individuals residing in Galveston County as needed.  For individuals with IDD, responsibilities include assisting individuals, families and care providers in developing individual service plans and comprehensive plan of cares for the caseload.  The services coordinator assists individuals and their families in identifying goals, identifying and advocating for resources/services, coordinating for the delivery of services, monitoring the progress of the plan and assisting with crisis prevention management.  Accurate documentation and billing of these services are required. The work environment is mostly field based (nursing facilities and home visits) and also requires some office work. 


  • Person Directed Planning (PDP) (ESSENTIAL) - Coordinates the service planning team for the development of the ISP through a person centered process that identifies strengths, preferences, medical, nursing, nutritional, clinical and support needs of the individual and the desired outcomes. 
  • Monitoring (ESSENTIAL) - Continual monitoring of all relevant standards for compliance (HHSC, TAC, etc).  Monitoring of the individual's progress in relation to the ISP.  Frequency of face to face monitoring is determined by the service coordination assessment tool and the needs of the individuals served and should be at a minimum, every 90 days. Maintaining contact with all of the relevant individuals as determined by the ISP and communicating with the individual or family regarding progress and/or changing needs. Maintaining close communication with facility psychiatric services (where applicable) and nursing, for input regarding medication compliance, side effects of medication, and medication changes and alerts these members of the staff of any changes in client adjustment which might suggest decomposition and a need for more aggressive intervention.
  • Rehabilitative Treatment Provider (Essential) - Provides RCM self management strategies and clinical coordination to individuals, groups, and family members as defined by GCC using evidence based strategies within the (TRR) model of care.  Provides monthly documented face to face hours of direct service per month to GCC consumers and/or family members as indicated in the current Direct Service Agreement for this position.  Monitors patients' requirements within the TRR model to ensure required services are offered and meeting targeted monthly service provision standard for identified caseload. Assure treatment provided to patient relates to the individualized goals of treatment plan. Utilizes a variety of skills training methods to include areas such as introduction, role play, behavioral reversal, in-vivo practice, and coaching.
  • Billing/Documentation (ESSENTIAL) - Accurately completes all required programmatic and administrative documentation within accepted timeframes. Ensures all required documentation has been forwarded to appropriate personnel and filed. Conducts the Adult Needs & Strengths Assessment (ANSA) every 6 months or as clinically indicated for individuals as required & assigned.  Responsible for ensuring staff completion of initial & annual ANSA recertification pursuant to the Praed Foundation & HHSC performance contract.  A lapse/expiration in certification will result in termination of employment. Exception:  If certification lapse/expiration is reported to supervisor within 24 hours of expiration date, employee will be granted opportunity to recertify by close of following business day.  Any lapse/expiration greater than 24 hours will result in termination of employment. Additionally, all certified practitioners are responsible for participating in semi-annual quality assurance training activity conducted by the identified ANSA/CANS Super User.
  • Special Projects (ESSENTIAL) - Assist Supervisor when requested to complete special projects within negotiated timeframes.
  • Corporate Compliance (ESSENTIAL) - Adherence to the professional, ethical and legal requirements set forth in the Center's Business Code of Conduct as well as the Corporate Compliance Plan. Strict adherence to authorizations and to all GCC policy guidelines outlined in GCC medication transport guidance letter when there is a need to transport patient medications. 
  • In Service Trainings (ESSENTIAL) - Completes all initial trainings to include NEO, SC training, PMAB, First Aid, CPR within 60 days of hire: obtain required updates/recertification as required. Participates in other continuing education trainings as required. 


  • Receives supervision from the MCSC Program Manager and oversight by  IDD Intake and PASRR Program Manager 


  • Non-Exempt under the Fair Labor Standards Act (Supervisor). Non-Direct Care


  • Bachelor's degree from an accredited college or university with a major in social, behavioral, health or human services and/or specialized QMHP certification.


  • One year of experience working with individuals with Mental Illness is required. One year of experience working with individuals with intellectual or developmental disabilities preferred. General knowledge of IDD and MI services and resources, good written and verbal communication skills, good time management and organizational skills. Two to three years full-time experience in human services preferred. Must be able to type 30 WPM with 80% accuracy.

Required License/Certification

  • Valid Texas driver's license. Must qualify for Center insurance coverage.

Working Conditions

  • Combination of field based work and office work / standard office environment
  • Will require travel and flexible hours, as needed