Care Coordinator II (Integration)

Job Type

Full Time


Details: DOE



Application Deadline



2950 International Boulevard
United States


Position:  Care Coordinator II (Integration)

Department:  Medical

Job Location:  Native American Health Center, 2950 International Blvd., Oakland, CA 945601

Work Hours:  Full Time, 100% FTE, 40 Hours per week

Position Summary: 

The Care Coordinator II will work in a fast-paced primary care setting as part of a multi-disciplinary team. Primary responsibilities will be advocacy, case management, health education, psychosocial assessments, following up on primary care outcomes and group facilitation. Remaining calm in stressful situations, superior customer service skill and understanding scope of practice are a must.


Duties and Responsibilities: 

Care Coordination Duties & Responsibilities

1. Facilitate integration of care for members by accepting warm hand offs from NAHC’s Medical providers and outside agencies.

2. Complete thorough biopsychosocial assessments to identify member needs, and connect them to appropriate NAHC services (Care Coordination, short term vs long term therapy, groups, etc)

3. Refer members to appropriate community agencies or facilities; acts as liaison with such organizations and advocate on members’ behalf as needed.

4. Provide crisis intervention and aftercare counseling and referrals.

5. Provide information and support about physical and mental health, substance use, tobacco recovery and available treatment options.

6. Collect data points for program deliverables as requested.

7. Panel manage members with complex needs to improve health outcomes.

8. Ensure completeness and accuracy of documentation into electronic health record (EHR) system, within 72 hours of member visit.

9. Participate in regularly scheduled group supervision, behavioral health rounds, and meetings including presentations and discussions.

Individual and Group Therapy Duties & Responsibilities

10. Under the clinical supervision of the IBH Program Manager, provide brief empirically supported behavioral health interventions at the individual and group level, to approved members.

11. Under the clinical supervision of the IBH Program Manager, facilitate behavioral health groups for members.

12. Screen and assess members for common mental health and substance use disorders. 

13. Monitor members for changes in clinical symptoms and treatment side effects or complications and collaborate with care team on treatment plan changes, as needed.

General Duties

14. Maintain the highest degree of confidentiality at all times.

15. Represent the program, department and agency in a positive and professional manner at all times.

16. Member Care: Demonstrate understanding and apply working knowledge of safety policies and ensuring safe member practices.

17. Employee Safety: Safely performs all duties; follows required protective protocols to ensure personal safety as well as the safety of others.

18. Maintain compliance with ergonomic safety standards; be mindful of posture and regularly practice ergonomic stretches.

19. Quality Improvement: Actively participate in internal quality improvement teams and work with members proactively to drive quality improvement initiatives in accordance with the mission and strategic goals of the organization, federal and state laws and regulations, and accreditation standards, when assigned. 

20. Work extremely well under pressure, meet multiple and often competing deadlines. 

21. At all times demonstrate cooperative behavior with supervisors, subordinates, colleagues, clients and the community.

22. Other duties as assigned by direct supervisors.


1.Masters degree in Clinical Social Work, Psychology or a related field.

2.At least 2 years’ of work experience providing care coordination services, counseling, or case management services. 

3.Fluency in both English and Spanish, is required per operational need.

4.Excellent communication skills.

5.If in recovery, 3 or more years of sobriety.

6.Working knowledge of common mental health and/or substance use disorders.

7.Working knowledge of evidence-based psychosocial interventions for common mental health disorders.

8.Experience working with members who have co-occurring mental health, substance abuse, and physical health problems.

9.Work experience providing crisis intervention.


1.Work experience in a community health setting, having worked with collaboratively with medical providers.

2.Knowledge of local community resources/services.

3.Knowledge of Federal/State regulations relative to social work.

4.Experience working with vulnerable, underserved, homeless and/or transient populations.

Additional Info: 

Note to Applicants: Please be advised a post job offer, pre-employment Physical and TB test are required as a condition of employment. Additionally, you may be asked to get a Department of Justice Fingerprinting clearance as a contingency for an offer of employment. Criminal clearances are obtained to protect the welfare and safety of clients receiving services at NAHC. Preference in hiring is given to qualified Native Americans in accordance with the Indian Preference Act (Title 25, US Code, Section 472 and 473). Applicants claiming Indian Preference must submit verification of Indian certified by tribe of affiliation or other acceptable documentation of Indian heritage. EQUAL OPPORTUNITY EMPLOYER: Within the scope of Indian Preference, all candidates will receive equal consideration without regard to race, color, gender, religion, national origin or other non-merit factors. Age Discrimination in Employment Act (ADEA): Native American Health Center abides by the mandates of the ADEA (protecting individuals 40 years and older) and considers age a non-merit factor in all employment decisions and considerations. Americans with Disabilities Act (ADA): Native American Health Center abides by the mandates of the ADA and considers disability a non-merit factor in all employment decisions and considerations. Furthermore, NAHC will make any practical, feasible, and reasonable arrangements to accommodate qualified applicants and employees with disabilities.


Benefits: Native American Health Center (NAHC) considers our employees to be our most valuable resource and offers an excellent benefit package: competitive salaries, personal time off (PTO) or sick/vacation leave program, and an employer contribution 403(b) retirement plan to full-time regular status employees. We also provide medical, vision, dental, flexible spending, group term and voluntary life insurance coverage for employees and their dependents—with a percentage of employee contribution for dependent medical premiums.

Level of Language Proficiency

Fluency in both English and Spanish, is required per operational need.

Professional Level

None specified

Minimum Education Required

Master's degree