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About the Role
Cornerstone Family Healthcare is actively recruiting for a Health Homes Care Manager to join our growing team in Newburgh, NY. This role provides core components of care coordination to individuals with chronic illnesses, including mental health conditions and HIV.
Responsibilities
- Provide core components of care coordination to individuals with chronic illnesses, including mental health conditions and HIV.
- Engage and assess HH clients to coordinate care using a shared care plan.
- Complete documentation in compliance with DOH, Health Home, and Agency standards.
- Coordinate with service providers to ensure client needs are addressed.
- Provide proactive care management and develop client-centered care plans.
- Utilize electronic health records for effective care coordination.
- Engage new HH clients into service and maintain engagement.
- Conduct intake and comprehensive health assessments/reassessments.
- Develop comprehensive, goal-oriented care plans in collaboration with external providers.
- Advocate and assist clients in obtaining entitlements and housing.
- Support clients in treatment adherence, including prevention, wellness, recovery, and care transitions.
- Refer and follow-up on referrals to ensure medical stabilization.
- Coordinate hospital discharges and follow-up on recommendations from ER or acute care facilities.
- Assist clients and families in resolving barriers to obtaining medical services.
- Escort clients to appointments when necessary.
- Conduct home and field visits.
- Maintain ongoing contact with medical providers, acting as team leader.
- Provide crisis intervention when required.
- Meet and maintain program productivity standards.
- Maintain Electronic Health Record and all required electronic data.
- Track and maintain a system of patient medical appointments, labs, and other critical activities.
- Complete all program standards documentation.
- Participate in supervision and program review.
- Attend and participate in required meetings.
- Be familiar with Cornerstone policies and procedures and the Employee Handbook.
- Maintain confidentiality of all aspects of Cornerstone.
- Perform other related duties as assigned.
Requirements
- Master’s degree in social work or related degree with some experience in the field.
- Bachelor’s degree in social work or related degree with experience/knowledge in case management, chemical dependency, mental health, and/or human services.
- LPN with 1 year of experience providing case management or medical coordination among multiple providers.
- Computer experience must include Microsoft Word and Excel.
- Experience with Electronic Health Records (EHR) data entry is a plus.
- Access to a car and valid driver’s license are required.
- Bilingual (English/Spanish) is a plus.
Skills
- Care coordination
- Documentation
- Electronic health records
- Microsoft Word
- Microsoft Excel
- Case management
- Chemical dependency
- Mental health
- Human services
- Crisis intervention
Location
- Newburgh, NY
Work Type
- Full-time
- Onsite
Experience Level
- 1 year of experience (for LPN requirement)
Education Level
- Master's degree in social work or related field
- Bachelor's degree in social work or related field
- LPN
Salary/Compensations
- $25.00 per hour
Benefits
- Competitive salaries
- Health Benefits
- Retirement plan
- Paid Time Off
- Sick Time
- Flexible Spending
- Dependent Care
- Paid Holidays
About the Company
- Cornerstone Family Healthcare is a non-profit Federally Qualified Health Center.
- Mission: To provide high quality, comprehensive, primary and preventative health care services in an environment of caring, dignity and respect to all people regardless of their ability to pay.
- For over fifty years, Cornerstone has been responsive to meeting the needs of the communities in which we serve with a continued emphasis on the underserved and those without access to health care regardless of race, economic status, age, sex, sexual orientation or disability.