Job Location:
Madonna Heights Campus
151 Burrs Ln
Dix Hills, NY 11746, USA

Responsibilities:

1. Engage referrals within 24 hours of receipt.
2. Maintain a 15+ client caseload or as determined by DOH.
3. Complete initial and ongoing needs assessments such as the Comprehensive Assessment and NYS Eligibility Assessment for HARP.
4. Responsible for the development and overall management of the Plan of Care (POC), including:
1. Coordinating the member’s provision of services, providing Care Coordination Services based on the member’s acuity level.
2. Supporting adherence to treatment recommendations and assisting/facilitating referrals, ensuring follow-through.
3. Monitoring and evaluating a member’s needs, including prevention, wellness, medical, mental health, care transitions, and social/community services.
5. Meet the standard billing requirement.
6. Provide the four required contacts per month, two of which are face-to-face.
7. Ensure documentation is completed timely and accurately by utilizing the daily activity log and electronic health record.
8. Function as an advocate for members within the agency and external service providers.
9. Promote wellness and prevention by linking members with resources and services based on their individual needs and preferences.
10. Educate the member/caregiver on chronic conditions, immunizations, screenings, and other preventative interventions.
11. Assist the member in obtaining and maintaining public benefits necessary for healthcare services, including Medicaid, Cash Assistance, Social Security, Supplemental Nutrition Assistance Program, Housing, Legal Services, Employment, and Training Supports.
12. Effectively communicate and share information with individuals and their families, considering language, literacy, and cultural preferences.
13. Conduct care planning meetings/conferences and serve as an interdisciplinary team member to provide/coordinate comprehensive and holistic care.
14. Identify available community-based resources and actively manage appropriate referrals, access, engagement, follow-up, and coordination of services.
15. In the event of hospital admissions, engage in the discharge planning process to ensure that the patient has recommended post-discharge services in place prior to discharge.
16. Attend and participate in ongoing staff development training to enhance skills needed for the Care Manager position.
17. Ensure all members enrolled have annual/periodic evaluations and follow-up treatment for dental, vision, and hearing care as per Medicaid EPSDT guidelines.
18. Perform all other duties as assigned.

Relationship with Others & in the Workplace:

1. Demonstrate professionalism at all times.
2. Maintain workplace boundaries.
3. Promote a productive and positive work atmosphere.
4. Uphold agency/program vision and mission in interactions with colleagues and families served.
5. Adhere to the agency Code of Conduct.

In addition, employees need to possess the following characteristics:

1. Strong team player.
2. Excellent communication and leadership skills.
3. Ability to work well with others and provide direction and guidance.
4. High level of confidentiality.
5. Develop trusting and supportive relationships with subordinates.
6. Sensitivity to cultural differences among staff and clients.
7. Belief in people’s ability to grow and change; forge respectful partnerships with persons served and their families.
8. Excellent crisis intervention skills and ability to remain calm in crisis situations.
9. Ability to set limits and maintain the helping role of practitioner.

Working Conditions:
This is an office/field-based position, which includes regular travel within Suffolk and Nassau Counties, as well as the 5 boroughs of NYC. All office days, staff meetings, and supervisory meetings are in-person at one of our two locations (Brooklyn/Dix Hills). Must reside in New York.

Qualifications:

1. Bilingual Preferred.
2. Health Home Care Managers serving adults with Health Home Plus status must have:
1. A Bachelor’s degree in Health and Human Services, OR
2. A Bachelor’s level education or higher in a related field with five years of experience working directly with persons with behavioral health diagnoses, OR
3. Credentialed Alcoholism and Substance Abuse Counselor (CASAC), OR
4. A Master’s with one year of relevant experience.
3. Expertise and experience in servicing youth, adults, and families in child welfare, developmental disabilities, mental health, healthcare, and/or other systems, as well as those receiving preventive services.
4. Passion and knowledge for advocating on behalf of staff, children, adults, and families.