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CTI Peer Care Manager

Summary

Title:CTI Peer Care Manager

ID:CTI001 (Catt)

Job Type:Full-time

Date Posted:10/21/2025

Openings:1

Department:CTI Grant

Description

Make a meaningful difference where it matters most.

At Monroe Plan, we're committed to supporting vulnerable communities through compassionate, person-centered care. We are currently seeking an Adult CTI Peer Care Manager to join our team in the Cattaraugus County area. In this role, you'll go beyond traditional case management - working hands-on to coordinate care, advocate for essential services, and help restore stability and dignity to those most at risk. If you're driven by purpose and ready to be part of a collaborative, mission-led team, we invite you to explore this impactful opportunity.

For over 50 years, Monroe Plan for Medical Care, a not-for-profit health care services organization, has been focused on improving the health status of individuals and families who are recipients of government sponsored health insurance. Monroe Plan is the largest Care Management Agencies serving 28 counties and over 3000 members with an outstanding reputation for excellence throughout our service area!

We’ve earned that reputation by providing quality care management focused on compassion, empowerment, and teamwork. Our award-winning work culture is built on these same principles! When you join our team, you can expect to reap the intrinsic rewards of serving others while enjoying flexible work arrangements, competitive pay, superior benefits, and a supportive, inclusive culture!

Candidate must be willing to travel throughout Cattaraugus County on a regular basis.

Grade 206: This is a full time position, working from home, but does require significant travel through Cattaraugus County. The minimum and maximum annual salary that Monroe Plan believes in good faith to be accurate for this position at the time of this posting are $39,123 - $47,817. In addition to your salary, Monroe Plan offers a comprehensive benefits package (all benefits are subject to eligibility requirements) and non-monetary perks. The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.

POSITION SUMMARY

The Peer Care Manager will provide Critical Time Intervention (CTI) services to identified and enrolled members. The Peer Care Manager will provide CTI services as a Care Manager from a lived-experience and non-clinical perspective. Peer Specialists will develop a person-centered care plan, share knowledge of community resources, provide linkage to resources, engage individuals in skill building, offer crisis management, collaborate with other providers, assist members in navigating complex systems, and work with information support. This position works with substantial independence in the field, with consultation available from Team Lead, as needed. The role will also require periodic on-call coverage, and a willingness to work flexible hours.

ESSENTIAL JOB DUTIES/FUNCTIONS

% of Time

Essential Function

50%

Outreach and Engagement

Outreach and Engagement

+ Persistent and assertive outreach and engagement using strength-based approaches beginning either at hospital or other transitional setting prior to discharge.

+ Early engagement with the member to build rapport and trust through multiple contacts, with at least one in-person contact prior to discharge.

+ Participate in hospital discharge planning meetings to identify member strengths and weaknesses.

+ Conduct an immediate needs assessment and gather contact information and any other needed information. Assessment process should be started using the hospital data system or PSYCKES to determine the history of treatment, existing resources, and other supports.

+ Assist with housing and transportation. Assist with appointment navigation including accompaniment to appointments, transportation training, reengagement in community care, and addressing barriers to care.

+ Facilitate and suggest other referrals that will maximize the success of the members’ discharge and recovery plan.

+ Adheres to Monroe Plan professional boundaries and protocols.

30%

Member/Provider Collaboration

+ Work in collaboration with providers to ensure everything is set according to discharge plan, in terms of treatment, support, and basic needs, assess needs such as income/benefits, cell phone access, transportation, food safety, adequate heat, lighting, etc.

+ Participate in hospital discharge planning meetings to identify the best community resources for returning members.

+ Foster relationships with community providers to ensure that members are connected with appropriate services as they transition back into the community. Document a Person-Centered Care Plan, in collaboration with the client and providers.

+ Work with interdisciplinary team (member, crisis supports, hospital treatment team) to resolve a crisis that requires admittance to an acute service (emergency department, CPEP/inpatient visit) to resolve the crisis and return the individual back to their community setting as soon as possible.

10%

Reporting

+ Collect and report data, as required and work with team leader and other CTI staff to use data to inform future care delivery.

+ Adhere to program documentation requirements in the Electronic Health Record.

+ Provide program information to members and providers, and other organizations as requested to introduce and support program participation.

10%

Communication

+ Presents in a professional and articulate manner that supports the development of a therapeutic relationship with the member and community providers.

+ Provide feedback to providers regarding the progress made and barriers encountered by their members.

+ Demonstrates listening skills to support member engagement and development of a person-centered plan of care.

Total must equal 100% - essential functions should be completed at least 10% of the time

OTHER FUNCTIONS AND RESPONSIBILITIES

+ Performs other duties as assigned.

+ Attend and participate in team meetings and supervisory sessions.

Position Limitations:

+ Cannot perform any tasks which are governed by license or registration (i.e. cannot answer questions or make recommendations RE diagnosis, medications or treatment).

+ Cannot transport active Monroe Plan members at any time.

+ Cannot perform hands on care.

MINIMUM REQUIREMENTS/LICENSES/CERTIFICATIONS

+ Minimum High School Diploma or equivalent or higher.

+ NYS Certified Peer Specialist preferred or required completion of an internship or comparable training in peer advocacy.

+ Experience in providing advocacy services to people who are mentally ill and/or homeless.

+ Knowledge of homeless resources, shelter systems and transportation systems.

+ Knowledge of counseling principles and methods for mental illness and substance use disorders.

+ Knowledge of treatment, rehabilitation, and community support programs as they relate to recipient/residents, families, and staff.

+ Ability to develop, evaluate, implement, and modify treatment intervention to meet the needs of individual recipients.

+ Ability to prepare accurate and timely reports.

+ Demonstrates ability to respect individual/family diversity and maintain confidentiality.

+ Demonstrates ability to work as a team member.

+ Knowledge of and ability to work collaboratively with providers and county/community health and human services.

+ Ability to demonstrate excellent communication skills both oral and written as well as strong interpersonal skills.

+ Proven ability to work independently and to manage time appropriately.

+ Strong organizational skills.

+ Computer literate. Must be able to pass computer documentation competency testing for all software platforms used within the program. This must occur within 3months of initial training and/or 6 months of hire, whichever comes first.

+ Candidates will need a NYS driver’s license and to own or have access to reliable transportation that enables them to fulfill travel requirements of the job including but not limited to, daily visits with members.

Preferred Qualifications

+ Past or current participant of behavioral health, substance services, or homeless services preferred.

+ Experience working with homeless and/or precariously housed populations preferred.

PHI MINIMUM NECESSARY USE: This staff position PHI access will be determined based on Minimum Necessary standards. The Minimum Necessary Grid can be found on the Human Resources and Compliance Web pages.

This job description is only a summary of the typical functions of the job, not an exhaustive or comprehensive list of all possible job responsibilities, tasks and duties. Additional responsibilities, tasks and duties may be assigned as necessary.

Monroe Plan for Medical Care is an Equal Opportunity Employer