JOB SUMMARY: The Support Coordinator (QIDP) is pivotal to ensuring that each individual receives coordinated, person-centered services that support a happy, healthy, meaningful, and fulfilling life. The Support Coordinator leads the person-centered planning process and ensures that services are developed, integrated, coordinated, implemented, monitored, and revised based on each individual’s strengths, preferences, priorities, assessed needs, and desired outcomes. The Support Coordinator serves as a primary connector among the individual, family/guardian, Residential Services, Direct Support Professionals (DSPs), DSP Trainers, clinical and therapeutic disciplines, and other members of the interdisciplinary team. In all responsibilities, the Support Coordinator models and advances St. Mary’s Home core values of Kind, Collaborative, Compassionate, Fun, Engaged, and Person-Centered, while ensuring continuous active treatment and helping each individual achieve a good life.
RESPONSIBILITIES:
The Support Coordinator role is central to the development, integration, coordination, implementation, and monitoring of active treatment and person-centered supports for each individual on the caseload. The Support Coordinator provides leadership for the ISP process and works collaboratively with the individual, family/guardian, Residential Services leadership, DSP Trainers, DSPs, and the interdisciplinary team to ensure plans are understood, implemented consistently, evaluated for effectiveness, and revised as needs and priorities change. Assurance is achieved through:
Treatment Planning:
- Familiarity with?Medicaid regulations?with regard to?Support Coordinator (QIDP) role and compliance with standards is required.?
- Involved?in admission planning and?comprehensive assessments?to ensure the suitability of placement and ability to provide services needed.?
- Leads a meaningful, person-centered planning process for each individual on the caseload. The individual’s voice, preferences, strengths, routines, relationships, culture, communication style, choices, goals, and vision for a good life must guide planning to the greatest extent possible. Ensures the individual and family/guardian, as appropriate, are supported to actively participate in Team meetings upon admission, at 30 days post-admission, annually, quarterly, and whenever changes in needs or priorities require review.
- Develops and maintains the Individual Support Plan (ISP) through the person-centered planning process, translating comprehensive assessments, evaluations, individual priorities, and interdisciplinary recommendations into clear, meaningful, measurable outcomes and supports. Ensures the ISP identifies what is important to and important for the individual, promotes choice and independence, and provides direct support staff with practical direction for consistent implementation across settings and shifts.
- Responds to concerns expressed by the individual, family/guardian, Residential Services staff, DSPs, DSP Trainers, or other interdisciplinary team members regarding supports, behavior, quality of life, implementation of the ISP, or significant changes in need. Convenes relevant team members, documents recommendations, communicates changes clearly, and collaborates with Residential Services leadership and DSP Trainers to ensure recommendations are implemented and necessary staff training, coaching, or competency follow-up occurs.
- Collaborates closely with the individual’s interdisciplinary support team, including Residential Services leadership, nursing, therapy, behavioral consultants (e.g., BCBA), community engagement, and other applicable disciplines, to develop or update behavior support plans and other components of the ISP in a timely manner. Follows up across departments to ensure supports are coordinated, person-centered, and consistently implemented.
- Ensures?follow up to recommendations for services, equipment or programs and documents in progress notes.?
- Ensures?that adequate environmental supports and assistive devices are available to promote independence.?
- Maintains a visible presence in the residential neighborhoods and provides assistance to unit staff as appropriate, including observation, coaching, problem-solving, and direct support of individuals when needed. Partners with Residential Services leadership, Team Leads, DSP Trainers, and DSPs to strengthen understanding of each individual’s plan and promote consistent, person-centered implementation.
- Monitors bed?board and closet?information?areas?for?each?individual?on their caseload?to?ensure that all?necessary information for direct support staff?is accurate and?thorough?
Monitoring and Documentation
- Is familiar with internal electronic systems to include?the company website,?electronic medical records (EMR) and health records (EHR)?and how these systems are used to:?
- Provide unit information per?individual,?track?event?reports?
- Provide information regarding activities?scheduled??
- Identify staffing?patterns?
- Document ISPs, progress notes?and required reports?for each department,?input?monthly summaries and quarterly reports, behavior support notes,?interdisciplinary team?meetings and recommendations.?
- Input details?on?each?individuals’?profile and support goals and documentation of services provided.? Filter for specific reports that provide information for coordination and monitoring of services.?
- Monitors?services provided to ensure compliance with requirements and report current status, progress or lack thereof in monthly summaries and quarterly reports, including reports from other departments.?
- Monitors?and reviews?data and progress towards?outcome achievement and revises?programs as needed based on current needs and performance.?
- Ensures consistency, through routine observations and review of documentation and data, in the implementation of ISPs, active treatment, behavior support plans, and other service designs across internal and external programs and disciplines. Identifies gaps between the written plan and actual practice and works collaboratively with Residential Services leadership, DSP Trainers, Team Leads, and relevant disciplines to develop corrective supports, retraining, coaching, or plan revisions as needed.
- Monitors?event reports affecting the?individuals?on the unit. Attends?QI “huddle” meeting when needed to review specific?event reports and ensure compliance with recommendations.?Submits recommendations and follows through as needed in response to any event reports related to active treatment or behavioral?support??
Training
- Collaborates with Residential Services leadership and DSP Trainers to develop, coordinate, and provide ongoing training, coaching, and reinforcement so DSPs and other staff understand each individual’s ISP, goals, outcomes, supports, preferences, communication needs, and active treatment expectations and can implement them accurately and consistently across all shifts.
- Provides subject-matter expertise regarding individual plans and assists Residential Services leadership and DSP Trainers in the design, development, and delivery of training and competency support to:
- Ensure staff understand how person-centered planning, ISPs, and continuous active treatment translate into daily routines, choices, interactions, skill development, community participation, and quality-of-life supports.
- Address individual-specific or unit-based training needs identified through observations, documentation review, event review, changes to the ISP, interdisciplinary recommendations, staff questions, or performance concerns.
- Works in partnership with Residential Services leadership, DSP Trainers, Talent/Professional Development, Team Leads, and relevant interdisciplinary department leaders to ensure training is timely, practical, consistent with the ISP, and reinforced through observation and follow-up. The Support Coordinator remains responsible for plan content and interpretation while partnering with trainers and operational leaders to support effective implementation.
Communication
- Maintains proactive, respectful, and collaborative communication among support team members, including the individual, family/guardian, DSPs, Team Leads, DSP Trainers, Residential Services leadership, nursing, therapists, community engagement, department leaders, and administration as appropriate. Serves as a go-to resource for questions about the individual’s ISP, priorities, supports, and interdisciplinary recommendations.
- Builds compassionate, trusting relationships with families/guardians and supports their active participation in person-centered planning and decision-making, while ensuring the individual’s preferences, rights, choices, and voice remain central to the process.
- Facilitates communication between external providers and departments within St. Mary’s by:?
- Developing and maintaining communication notebooks to go with the?individual?to school or day programs that assists in the collaboration of services and addresses any immediate needs.?
- Referring concerns from school or day programs to appropriate departments within the facility.
- Attending?IEPs?or other scheduled?meetings at schools or day programs?to ensure consistency in programming and collaboration between services.? Acts as an advocate for?individuals?and on behalf of families in IEP meetings or?with?other external programs.?
- Conducting regular visitation/observation?on behalf of?each?individual?in the schools or day programs.??
- Collecting information/data related to?IEP/ISP progress for?each?individual?in the schools or day programs.?
- Is actively involved in resolving any discrepancies or conflicts between programmatic, medical, dietary, school, day program and/or vocational aspects of the individual’s assessment and program planning.?
- Participates in and, as appropriate, facilitates routine unit-based meetings across shifts with Residential Services leadership, DSP Trainers, Team Leads, and direct care staff to gather and share information related to active treatment and ISP implementation, provide individual-specific education, answer questions, identify barriers, and reinforce consistent person-centered supports.
Other
- Immediately addresses?any unforeseen emergencies (i.e.?unauthorized use of restraints, uncooperative service providers,?etc.) with appropriate authorities.?
- Meets routinely with the Program Manager and other Residential Services leadership to discuss individual needs, ISP implementation, staff support needs, changes to services/programs, regulatory or policy updates, quality concerns, and opportunities to improve coordination and outcomes. Maintains regular partnership with DSP Trainers to identify trends and prioritize ongoing plan-implementation training across shifts.
- Recommends?improvements to program monitoring?and delivery systems as appropriate to increase efficiency or effectiveness of services.???
- Provides?feedback to respective department supervisors on performance of staff members assigned to that department to include outstanding or poor performance of duties.?
Professional Conduct
This leadership position requires professional communication, behavior, judgment, and accountability. The Support Coordinator is expected to model St. Mary’s Home core values in daily practice: Kind in communication and interactions; Collaborative in partnering across roles and disciplines; Compassionate in understanding the experiences and needs of individuals, families, and staff; Fun in helping create meaningful, joyful opportunities and a positive culture; Engaged through visible, responsive, and active participation in the residential neighborhoods; and Person-Centered by keeping each individual’s voice, preferences, rights, strengths, and vision for a good life at the center of decisions. A respectful, courteous, positive, and solutions-focused approach is expected in all encounters, along with compliance with attendance and punctuality policies and flexibility to meet family needs, attend necessary meetings, and support training across shifts.
Qualifications
- QIDP requires one of the following:??
- A?doctor of medicine?or osteopathy licensed in?Virginia?
- A registered nurse licensed in Virginia, or?
- A bachelor’s degree in a human services field including but not limited to sociology, social work, special education, rehabilitation counseling or psychology, or a bachelor’s degree in another field in addition to and advanced degree in a human services field.?
- At least 1 year of experience working directly with persons having severe developmental and physical?disabilities??
- Background in?developing and implementing service?plans?
- Current acceptable driving record and valid VA driver’s license.?
- Strong communication, organizational, time management and multi-tasking skills.??
- Prior experience working with children?and/or young adults?with multiple disabilities is preferred.??
- Computer skills especially with Microsoft?word, power point and excel.??
Some knowledge and experience with electronic health records?preferred?
Physical Requirements of the Job
- Ability to sit, stand and walk for variable periods of time.?
- Ability?able to lift 35 pounds independently.
- Specific vision, verbal communication, and hearing abilities are necessary for some functions of the position.???
- Ability?to use lifting and mobility equipment necessary to care for the residents.
Job Knowledge
- Ability to actively contribute to and build collaborative interdisciplinary teams, including effective partnership with Residential Services leadership, DSP Trainers, Team Leads, DSPs, families/guardians, and clinical/therapeutic disciplines.
- Ability to provide, coordinate, and reinforce ongoing professional in-service education, individual-specific ISP training, coaching, and competency support in partnership with Residential Services leadership and DSP Trainers.
- Ability to ensure that staff understand the intent and requirements of each individual’s ISP and are capable of translating the plan into consistent, person-centered daily supports and active treatment across shifts and settings.
- Ability?to be?confident and have the capability of conducting activities in a productive, orderly and efficient manner.?
- Demonstrated commitment to person-centered planning and ability to successfully complete Person-Centered Thinking training developed by The Learning Community for Person Centered Practices. Preference will be given to those who are also a Person-Centered Thinking Coach. The Support Coordinator must be able to facilitate planning that reflects the individual’s voice, strengths, preferences, choices, relationships, desired outcomes, and vision for a good life.
- Ability to successfully?complete?the approved behavior and crisis management program at St. Mary’s Home.???
Notice of AI Use in Job Application Review
As part of our commitment in creating a fair, efficient, and consistent hiring process we may use artificial intelligence (AI) to help our recruiting teams organize, summarize, and analyze information provided by candidates, including resumes, application responses, and other materials submitted during the application process.AI may be used to identify patterns, highlight relevant skills, and experience, and assist in comparing a candidate’s qualifications with the requirement of a specific role. These tools are to improve efficiency and consistency while supporting more informed hiring decisions, which will ultimately be made by the hiring team.