CORE Services Coordinator Peer Certified

Description

POSITION SUMMARY

For almost 80 years, Fountain House has been developing the clubhouse model, an intentionally designed community where people with serious mental illness support each other toward recovery and the achievement of personal, social, and employment & educational goals. Clubhouse members participate in selecting staff to support the community and to work side-by-side with them to operate the clubhouse. This very intentional strengths-based and relationship-oriented culture requires staff who are fiercely optimistic, professionally curious, flexible, and resilient communitarians. You must be willing to take creative risks and to persist in finding solutions, maintaining hope in the face of all the challenges our clubhouse members experience. We are looking for people who are energized by helping others and being part of a genuine and dynamic community.

Fountain House’s Community Oriented Recovery and Empowerment (CORE) Services program serves individuals living with severe and persistent mental illness, including Medicaid HARP enrollees, and supports individuals in achieving their personal recovery, wellness, and community integration goals.

The CORE Services Coordinator / Certified Peer Specialist is a hybrid direct-service, peer support, service coordination, outreach, and administrative role. The position provides Peer Support and Psychosocial Rehabilitation services while also conducting assessments, developing individualized service plans, coordinating care, completing documentation, managing intakes, and supporting program compliance.

The Coordinator builds trusting, recovery-oriented relationships with members and provides services in members’ homes, in the community, and at Fountain House. Support may include wellness and recovery coaching, advocacy, community integration, education and employment support, housing and benefits navigation, independent living skills, development of natural supports, appointment support, transportation assistance, and connection to medical, behavioral health, and community resources.

The Coordinator also conducts person-centered outreach and engagement with individuals who may be eligible for CORE Services and develops relationships with Care Management Agencies (CMAs), Managed Care Organizations (MCOs), treatment providers, and community organizations. Outreach focuses on helping individuals understand available services and determine whether CORE aligns with their needs, preferences, and recovery goals, rather than simply recruiting participants.

The CORE Services Coordinator / Certified Peer Specialist embodies Fountain House’s HERO characteristics: fierce optimism, professional curiosity, and a deeply communitarian approach to engagement and community building.

Requirements

Direct Peer Service & Member Engagement

• •Maintain an assigned caseload and provide one-on-one Peer Support and Psychosocial Rehabilitation services based on member needs, preferences, and individualized service plans.
• •Build authentic, trusting relationships that promote hope, recovery, self-determination, and community participation.
• •Support members in goals related to wellness, housing, education, employment, relationships, benefits, independent living, community connection, and recovery.
• •Use person-centered, trauma-informed, culturally responsive, strength-based, and motivational interviewing approaches.
• •Appropriately draw upon lived experience to support engagement, self-advocacy, and recovery.
• •Assist members with recovery tools such as Wellness Recovery Action Plans (WRAP), relapse prevention planning, and other self-directed supports.
• •Provide advocacy, outreach, recovery support, health and wellness coaching, transitional support, and pre-crisis/crisis support within the scope of the position.
• •Assist with transportation, travel training, and attendance at medical, behavioral health, and other appointments as appropriate.
• •Connect members with natural supports, community resources, and formal service systems.

Assessment, Service Planning & Coordination

• •Conduct intake and service assessments using a person-centered, trauma-informed, culturally competent, and recovery-oriented approach.
• •Identify member strengths, needs, preferences, and personally meaningful goals.
• •Develop, implement, and regularly review Individualized Service Plans (ISPs).
• •Support transitions into, within, and out of CORE Services, including discharge and transition planning.
• •Identify barriers to service delivery and work collaboratively with members and providers to address them.
• •Participate in CORE team meetings and collaborate with the Director of CORE Services on member care and program needs.

Person-Centered Outreach & Engagement

• •Conduct person-centered outreach to individuals who may be eligible for CORE Services.
• •Explain CORE services in clear and accessible language and help individuals explore whether available supports align with their goals and preferences.
• •Follow up with referred individuals and address barriers to engagement using a flexible, individualized approach.
• •Develop relationships with CMAs, treatment providers, hospitals, community organizations, and other referral partners to increase awareness of CORE Services.
• •Provide education regarding CORE eligibility, available services, and the referral process.
• •Support appropriate referrals while maintaining the individual’s voice, choice, privacy, and self-determination.
• •Participate in community outreach, presentations, meetings, and educational activities.

Administrative, Documentation & Compliance

• •Manage incoming CORE referrals, enrollment activities, and required documentation.
• •Verify member eligibility using applicable systems, including Healthix, PSYCKES, and EPACES.
• •Maintain accurate and organized member records in AWARDS, the electronic health record (EHR).
• •Complete timely, comprehensive progress notes documenting services, including required time, location, interventions, member response, and follow-up.
• •Maintain compliance with Fountain House, New York State Office of Mental Health, Medicaid, and Managed Care Organization requirements.
• •Assist with quality improvement, program development, and other duties as assigned.

Training & Professional Development

• •Complete required Fountain House, OMH, Medicaid, and MCO trainings and competency requirements.
• •Maintain required peer certification and participate in supervision, consultation, team meetings, and professional development.
• •Maintain current knowledge of CORE regulations, documentation requirements, and recovery-oriented practices.

REQUIRED KNOWLEDGE, SKILLS & ABILITIES

• •Knowledge of Peer Support, recovery-oriented, person-centered, and trauma-informed practices.
• •Ability to appropriately use lived experience to foster hope, engagement, self-advocacy, and recovery.
• •Knowledge of motivational interviewing and strengths-based engagement.
• •Ability to build trusting relationships with members and community partners.
• •Excellent interpersonal, verbal, and written communication skills.
• •Strong organizational skills and attention to detail.
• •Ability to balance direct service delivery with documentation, authorization, outreach, and compliance responsibilities.
• •Ability to manage multiple priorities and meet strict deadlines.
• •Ability to work independently and collaboratively as part of a team.
• •Working knowledge of electronic health records and Microsoft Office, including Word, Excel, and Outlook.
• •Knowledge of Medicaid, Social Security, benefits, and community resources preferred.
• •Ability and willingness to travel throughout the five boroughs using public transportation.
• •Spanish proficiency desirable.

EDUCATION, CERTIFICATION & CREDENTIALS

• •Bachelor’s degree required, preferably in health-related field.
• •NYS Peer Specialist Certification (Provisional or Full), or NY Certified Peer Recovery Advocate (NYCRPA) certification.
• •Certific