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About the Role

The Senior Care Coordinator is responsible for specialty retention and adherence specific care coordination services, including comprehensive screenings, assessments, and service planning to improve the health and well-being of people living with HIV/AIDS. This role aims to reduce viral load and support patients in managing their healthcare, addressing medical, behavioral health, community services, and social determinants of health for high-need individuals. The Senior Care Coordinator also serves as a member of the multi-disciplinary team, assisting in staff training and maintaining community relationships.

Responsibilities

Manages oversight for care coordination activities for specialty retention and adherence specific caseload
Conducts outreach and engagement for assigned program participants
Develops enhanced service plans to address medical, mental health, substance use, and social services needs
Maintains assigned caseload of patients in all phases of case management and meets productivity rates
Assists patients to achieve outcomes as required by NYSDOH, The AIDS Institute, and other regulatory bodies
Provides training to staff to ensure full knowledge of their position functions
Identifies and maintains relationships with community-based organizations for referrals and linkages
Conducts outreach, education, and consultation to community-based organizations about provided services
Enters data accurately on web-based reporting systems and electronic medical records
Assists Data Analyst and Program Manager with monthly and yearly reports
Monitors patients' treatment and medication adherence, as well as authorizations for medications
Ensures all documentation meets regulatory, funding, and agency requirements, including assessments, notes, and care/service/treatment plans
Conducts face-to-face intakes and assessments in the community, on program sites, or during home visits
Demonstrates knowledge of development across the lifespan, cultural and linguistic norms of minority populations, and awareness of socioeconomic health disparities
Provides education, encourages retention in care, adherence to medical treatment, and strategies for promoting chronic disease self-management
Manages referrals to appropriate agencies to assist clients in achieving goals identified in the Care/Treatment/Service Plan
Participates in multidisciplinary team meetings, case conferences, and service planning meetings
Assists clients in accessing programs that will help pay for medical care and prescriptions
Oversees transfers, inactivation, and discharge processes
Ensures timely documentation in the electronic health record and designated State and/or Federal data management systems
Participates in Performance Improvement/Continuous Quality Improvement activities
Demonstrates excellence in internal and external customer service
Understands and effectively communicates HIPAA compliance, corporate compliance, and client confidentiality
Ensures and/or remains in compliance with local, state, and federal regulations (NCQA, Joint Commission, NYS Department of Health, HRSA)
Adheres to the National Patient Safety Goals
Completes other duties as assigned

Requirements

Bachelor’s degree in Psychology, Sociology, Social Work, or Nursing
Two (2) years’ work experience in case management/care coordination with populations including persons with HIV/AIDS, HCV, women, children & families, persons with MR/DD, or persons with mental health or substance use disorders
Strong written and verbal communication skills
Excellent customer service skills
High level of cultural competency, professionalism, and flexibility
Ability to adhere to strict confidentiality guidelines
Experience with public speaking and group training
Working knowledge of computers and Microsoft Office programs
Clean license and valid driver’s license (verified annually)
Proof of adequate auto insurance in compliance with NYS mandatory limits and coverage

Skills

Case management
Care coordination
HIV/AIDS
HCV
Women, children & families
MR/DD
Mental health disorders
Substance use disorders
Written communication
Verbal communication
Customer service
Cultural competency
Professionalism
Flexibility
Confidentiality
Public speaking
Group training
Computer proficiency
Microsoft Office
Bilingual (English/Spanish)
New York State Department of Health AIDS Institute Reporting Software

Location

Community
Program site
Home visits

Work Type

Full-time

Experience Level

Senior
Two (2) years’ work experience

Education Level

Bachelor’s degree

Salary/Compensations

$24.00 - $26.00 hourly

Equal Opportunity

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other legally protected status.