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About the Role

The Health Home Care Manager provides care coordination and support to clients with chronic medical and behavioral health conditions, assisting them in navigating social service, community, and healthcare systems.

Responsibilities

• Works closely with the interdisciplinary care team in the development and ongoing coordination of the care plan.
• Works closely with the Patient Navigator to direct field activity and ensure optimized information flow.
• Provides input to providers/patient/family for written individualized care plans.
• Reviews patient intake assessments and uses results to coordinate the care plan, self-management goals, and strategies.
• Identifies potential barriers to care with the patient and helps them overcome these barriers.
• Evaluates medication compliance and assesses potential barriers to adherence.
• Receives alerts for inpatient and ER admissions, visits patients during inpatient stays, and participates in discharge planning.
• Contacts patients within one business day after discharge from inpatient services and ER.
• Helps patients keep scheduled appointments and arranges for appropriate metabolic and preventive screenings.
• Ensures patients and caregivers are aware of test results by facilitating discussions between patient and physician.
• Coordinates services between patient and extended care team providers to ensure integrated care plan implementation.
• Reviews workload reports to identify patients requiring assessments, outreach, and engagement.
• Provides or arranges for self-management/wellness education, peer, and other support groups in the patient/family's preferred language.
• Organizes and participates in case conferences as per patient need.
• Reviews benefits, entitlements, and housing with the patient/family and assists in the application process.
• Utilizes the TREAT system to complete all documentation and assessments timely, including scheduling.

Requirements

• Minimum High School diploma/ GED.
• Minimum 2 years of work-related experience.

Location

• Manhattan, NY

Work Type

• Full-time

Experience Level

• 2 years

Education Level

• High School diploma/ GED
• Bachelor’s degree in Health or Human Services related field

Salary/Compensations

• $23.00 - $26.37 per hour

Benefits

• $1,500 sign-on bonus. Terms and conditions apply

About the Company

• Sun River Health provides the highest quality of comprehensive primary, preventative and behavioral health services to all who seek it, regardless of insurance status and ability to pay, especially for the underserved and vulnerable.
• Sun River Health is a Federally Qualified, Non-Profit Health Center serving communities in Suffolk, Rockland, Orange, Dutchess, Ulster, Sullivan, Columbia and Westchester County.