Care Coordinator - Keene, NH


The Continuing Care Coordinator is responsible for co-developing and creating the transition plan, which includes referrals for each patient along with providing sound, therapeutic treatment. This position will ensure patients transitioning from PHNE Keene have all necessary services in place including but not limited to: safe and appropriate housing; medical appointments; psychiatric/mental health appointment; identified support group meetings; family services; aftercare services. He/she/they plans, advocates, implements and coordinates a proactive array of comprehensive, individualized services for patients and performs administrative work in support of the program.


  • Work with patients to develop realistic transition plans that are measurable, coherent and reflective of patient's progress and development, and which maximize available community resources.  Transition plans will address post discharge housing, coordination of aftercare, medical and psychiatric care, family services and any additional needs identified during the admission or treatment process.
    • Work with patients to identify options for post discharge living situations and facilitate appointments when necessary to ensure seamless transition from PHNE Keene to safe and appropriate living situations
    • Ensure all necessary post discharge appointments have been set prior to discharge 
  • Assist patients in enrolling in insurance programs.
  • Transport patients to appointments in Phoenix House vehicle.
  • Review and sign all patient transition plans and assessments in a timely fashion.
  • Contact and interact with family members of patients to ensure understating and engagement in the transition plan.  Provide resources to family members as appropriate.
  • Maintain positive working relationship with agencies, resources, and families to coordinate services for patient care; provide information on substance abuse treatment resources and services; and make necessary referrals.
  • Provide patients with individual, group, and educational services as assigned.
  • Provide other treatment services such as morning meeting, evening meeting, monitor meds, and supervise urine screening.
  • Respond to patient crises and emergencies as needed.
  • Maintain patient charts to comply with CARF and/or other state agency standards, using Welligent Electronic Medical Record.
  • Maintain accurate, timely, legible case notes, session notes and group notes.  Document developments and important events in accordance with clinical policies for reporting and record keeping.  Use Phoenix House systems, including Welligent, effectively and appropriately.
  • Attend and participate in staff meetings, Team Treatment meetings, Group Supervision, Individual Supervision, case conferences, and required training, as assigned, to ensure continuum and quality of care.
  • Meet with supervisor on a regular basis.
  • Serve as a rolemodel through positive, appropriate conduct and participation in special agency events.  Project a good image to the public.
  • Dress in a professional manner in accordance with the Dress Code.
  • Participate in the support and training of other staff members.


  • Demonstrated proficiency in Phoenix House's electronic health record system (Welligent) sufficient to fulfill the duties required by this position is expected within 15 days of employment.

·  Demonstrate empathy and compassion for patients in individual, groups and daily interactions

  • Maintain objectivity towards all patients and make clinical decisions based on accurate information.
  • Hold patients accountable effectively and with appropriate frequency, using a variety of privileges and sanctions.
  • Demonstrate appropriate professional boundaries between self and patients.
  • Promote self-help concept within program.  Encourage patients to solve their own problems and encourage patients to use each other for support.
  • Play appropriate role as continuing care coordinator, serving as guide in the self-help recovery process.
  • Track progress of patients assigned.
  • Implement daily schedule of program activities. Enforce rules and programmatic procedures.  Monitor and facilitate program activities. Engage in surveillance activities.
  • Work cooperatively with others and supervisors.
  • Develop, maintain, and enhance relationships with continuing care referral agencies throughout the region.
  • Demonstrate patience and consideration in dealing with others.
  • Demonstrate thoughtful decision-making.
  • Ensure patient confidentiality in accordance with all federal, state, and local laws and regulations.


To perform this position successfully, you must be able to perform each essential duty and responsibility satisfactorily.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential duties and responsibilities.  The requirements listed below are representative of the knowledge, skill and/or ability required. 

§  Ability to develop rapport with patients and their families and communities.

§  Ability to apply organizational management skills and maintain self and patient accountability

§  Ability to prepare and maintain required documentation. 

§  Ability to comply with internal, local, state, and federal regulations and policies.

§  Ability to work and communicate with others.

EDUCATION/EXPERIENCE:  Associates Degree from an accredited institution or equivalent combination of knowledge and experience.

LICENSES/CERTIFICATIONS:  Minimal CRSW or eligible within 9 months of hire.

Must have a valid driver's license that meets Phoenix House requirements to drive a Phoenix House vehicle.


The physical demands described here are representative of those that must be met by an employee to successfully perform the essential duties and responsibilities of this position.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential duties and responsibilities.

REGULARLY REQUIRED: To sit, use hands to finger, handle or feel objects, tools or controls; reach with hands and arms, and talk or hear.

OCCASIONALLY REQUIRED: To stand, walk, stoop, kneel or crouch and lift and/or move up to 10 pounds


The work environment characteristics described here are representative of those an employee encounters while performing the essential duties and responsibilities of this position.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential duties and responsibilities.

The work environment is that of a substance abuse treatment milieu which may include:

  • Exposure to patients infected with Hepatitis B, HIV, TB, or other Infectious Diseases
  • Weekend and holiday hours
  • Business-related travel


Weekend, evening and/or holiday shifts may be required. Scheduled days and/or times may be adjusted to ensure 24/7 coverage of a residential facility.

Phoenix House requires background checks, drug testing, TB testing, verification of employment history, reference checks and possibly a medical exam, prior to employment.

Phoenix House is an Equal Opportunity Employer providing equality of opportunity to all who are protected against discrimination by law, regulation or executive order, including veterans and individuals with disabilities. EEO is the Law: Applicants and employees are protected under Federal law from discrimination. Click to learn more.

JOD ID: 75