26 Bay Street
TITLE Care Manager
REPORTS TO: Program Director
DEPARTMENT: Health Home
POSITION STATUS: Full time
FLSA Status: Non-Exempt
The Care Manager will be responsible for providing support to clients with a high need for clinical and support services.
- Utilizes approved Health Home clinical tools and technology to prepare initial and ongoing clinical and psychosocial assessments of service needs of identified clients. Confirms acuity level of identified client and tailors care plan accordingly, reassessing as needed.
- Develops, coordinates and integrates a coordinated care plan in cooperation with the client, the client’s family, and/or the other providers serving the patient. Updates plan at specified intervals, and as needed based on changes in client’s condition / circumstances.
- Participate in integrated care efforts with all providers known to the client to monitor the treatment plan and treatment progress
- Performs and maintains effective care management for a caseload of clients, as assigned, from assessment to discharge.
- Tracks/ monitors client progress and produces/maintains detailed, accurate and timely case notes.
- Facilitates periodic case record reviews and case conferences with all providers serving the patient.
- Reviews new cases for completeness of documentation.
- Provides linkage, coordination with, referral to and follow-up with appropriate ongoing service providers.
- Attends planning meetings with service providers to coordinate service plans. Works effectively with interdisciplinary team of providers including PCP, substance abuse treatment, residential, hospital discharge planners, etc., to coordinate care delivery between all linked providers and client
- Maintains updated case records through health home EMR, and coordinates effective electronic communication throughout all provider databases, as needed. Maintains case records in accordance with health home policies/procedures, agency standards and regulatory requirements.
- Participates and consults with team supervisor in case conferences, staff meetings, and discharge planning meetings to determine if client requires an alternate level of care or is appropriate for discharge.
- Performs other duties and participates in special projects, as required.
A bachelor’s degree in any of the following: child & family studies, community mental health, counseling, education, nursing, occupational therapy, physical therapy, psychology, recreation, recreation therapy, rehabilitation, social work, sociology, or speech and hearing; OR
NYS licensure and current registration as a Registered Nurse and a bachelor’s degree;
OR a Bachelor’s level education or higher in any field with five years of experience working directly with persons with behavioral health diagnoses; OR a Credentialed Alcoholism and Substance Abuse Counselor (CASAC).
Two years of experience (a Master’s degree in a related field may substitute for one year’s experience) in providing direct services to persons diagnosed with mental disabilities, developmental disabilities, alcoholism or substance abuse OR in linking persons who have been diagnosed with mental disabilities, developmental disabilities, alcoholism or substance abuse to a broad range of services essential to successfully living in a community setting.
Ability to communicate well with medical providers and support staff. Ability to work well with diverse population. Ability to handle multiple tasks and stressful environment. Ability to work well within the organizational structure. Ability to work flexible hours including some evenings and weekends. Ability to use common office software. (Word, Excel, Power Point). Familiarity with ECW preferred. Effective oral/written/interpersonal communication skills required. Bilingual skills preferred, and may be required as determined by operational needs. Basic computer skills required.
- Business Acumen
- Communications (written and oral)
- Customer Focus
- Interpersonal Effectiveness
- Problem Solving
- Teamwork and Collaboration
Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public.
Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages, area, circumference, and volume. Ability to apply concepts of basic algebra and geometry.
This position will be evaluated based on the incumbent’s ability to prioritize, time management skills and flexibility. In addition, the incumbent’s performance will be measured and evaluated according to the standardized tool used for all employees providing service to internal and external customers and incorporating Community Health Action’s Core Values.
Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Full Medical,Dental, and Vision benefits.
Level of Language Proficiency
English and Bilingual English/Spanish
Minimum Education Required