About the Role
Provides integrated care management services to patients using a harm reduction approach to address psychosocial barriers to care. Responsibilities include care coordination, psychoeducation, casework counseling, linkage to community supports, referral follow-up, and maintaining communication with patients and care teams. Attends ongoing training to address patient needs including understanding of HIV, Substance Use, Hepatitis C, mental health, and chronic conditions.
Responsibilities
- Complete care management intakes and comprehensive patient assessments
- Develop, implement, and monitor individualized patient care plans
- Establish linkages and refer patients to internal and external support services; provide follow-up on referrals
- Complete patient Recovery Support Plans and Crisis Plans as appropriate
- Communicate and collaborate effectively with patients and interdisciplinary care teams, including providers
- Provide Naloxone training to patients and staff
- Conduct and/or support HIV testing and ensure linkage to appropriate services and follow-up
- Participate in case conferencing with care teams
- Maintain accurate, current case records and complete required documentation and reports in a timely manner
- Demonstrate knowledge of stages of change, substance use disorders, HIV, HCV, and other co-occurring conditions
- Empower, educate, and link patients to HIV, HCV, and STI testing and treatment, PrEP, substance use services, and primary care
- Participate in ongoing training to enhance professional skills and patient care
- Support quality improvement initiatives and perform other duties as assigned
Requirements
- Ability to communicate in English, both orally and in writing
- Ability to communicate in Spanish, both orally and in writing, preferred
- Experience in health or social services
- Knowledge of the geographic community served and available resources
- Maintains a customer service level commensurate with the expectations of the Mission Statement
- Ability to collaborate with other members of Hudson River HealthCare to maintain high-quality standards and achieve client satisfaction
- Possesses the emotional, mental, and physical capability to perform duties and demonstrates a strong commitment to achieving goals
- Demonstrates initiative, enthusiasm, creativity, and strong verbal and written communication skills
- Ability to organize work effectively, accept and utilize guidance, and work cooperatively
- Possesses flexibility, cultural sensitivity, and the ability to maintain confidentiality
Skills
- Harm reduction approach
- Care coordination
- Psychoeducation
- Casework counseling
- Linkage to community supports
- Referral follow-up
- Communication with patients and care teams
- Understanding of HIV
- Understanding of Substance Use
- Understanding of Hepatitis C
- Understanding of mental health
- Understanding of chronic conditions
- HIV testing
- Naloxone training
- Stages of change
- Substance use disorders
- STI testing and treatment
- PrEP
- Substance use services
- Primary care
Location
- Riverhead
Work Type
- Full-Time
Education Level
- High School Diploma or GED
- Associate degree preferred
- Certified Recovery Peer Advocate (CRPA) preferred
Salary/Compensations
- $23.00 - $24.68 per hour
About the Company
- Sun River Health has a rich history of providing quality, affordable health care to communities in need.
- Founded in the early 1970s by four African American women in Peekskill, New York, the organization was established to address the lack of accessible health services in their community.
- With the help of a small federal grant, the first Sun River Health site opened its doors in 1975.
- Over the years, Sun River Health has grown into a comprehensive Federally Qualified Health Center (FQHC) system with over 45 locations, serving more than 250,000 patients across the Hudson Valley, New York City and Long Island.
- Our exceptional primary care practitioners, specialists and support staff are dedicated to delivering high-quality care to all individuals, regardless of their ability to pay.
- In December 2018, Sun River Health expanded its reach by merging with Brightpoint Health, an FQHC network offering integrated medical, behavioral and social support services in New York City.
- This merger allowed us to enhance our services and continue our mission under the unified name of Sun River Health.
- At Sun River Health, we believe in fostering a culture of wellness, inclusivity and recognition.
- Our Workforce Wellness Program promotes staff wellness through ongoing challenges and activities, encouraging participation and rewarding engagement.
- We celebrate our staff's dedication and person-centered spirit through the Planetree Recognition Awards, which honor innovation, leadership and community spirit.
- We are committed to creating a supportive and collaborative work environment where all team members can thrive.
- Our values of respect, integrity and excellence guide our interactions with patients and colleagues alike, ensuring that everyone receives the care and support they deserve.
- Be part of a proud network of care that offers high-quality health and social support services to communities in need.
- We provide opportunities for career advancement and professional development.
- Our culture promotes wellness, inclusivity, and recognition, ensuring a supportive and collaborative work environment.
- Make a difference in the lives of individuals and families by providing quality, affordable health care.
- Join us at Sun River Health and be part of an award-winning network of care that has been serving our communities since 1975.
- We are always looking for skilled and dedicated professionals to join our team and help us continue our mission of providing quality health care to all.
