Job #: 3005
Title: Care Coordinator
Care Coordinators link adults and children with chronic behavioral health and medical conditions to the services they need to stay as healthy as possible and inspire the people they serve (members) to use those services to optimize their health outcomes. Working in a team setting and primarily in the field, Care Coordinators assess risk and needs, develop person centered care plans, provide care management services, track and arrange appointments, educate members and coordinate other aspects of members’ health and community services. As this is an evolving program, additional responsibilities will be added.
KEY ESSENTIAL FUNCTIONS:
Integration of medical, specialized and behavioral health services in addition to social support and/or educational support services
Periodic assessment of a member’s medical and behavioral health needs as well as compliance with recommended treatments
Collaborative development of an Individualized Care Plan (ICP) with the member, the member’s family and/or caregivers in addition to other service providers
Providing required care management services
Tracking all specialty medical, behavioral and support service referrals made for patient using Health Information Technology (HIT) provided.
Assuring that member has access to, engages in and retains needed services as defined in the member’s ICP. Such services may include: Acute Medical Care; Primary Medical Care; Preventative medical care services (including metabolic screening); Home Health Care; Chemical Dependency Services; Behavioral Health Services; Community social support services; Housing; State and federal entitlements; Educational services; Involvement with child welfare, juvenile justice or criminal justice institutions.
Providing outreach services to members for increased access to the above services
Responding to members’ information and referral questions.
Reassessing the need for ongoing care coordination services
Completing all required documentation
Sharing knowledge and experience with other team members to support the team’s overall service provision efforts
Carrying an agency-provided cell phone
Responding to member crises during (and occasionally outside of) regular business hours
Other duties as assigned
EDUCATION /TRAINING REQUIRED:
A bachelor’s degree with a major or concentration (minimum of 24 credits) in social work, psychology, nursing, rehabilitation, education, occupational therapy, physical therapy, recreation or recreation therapy, counseling, community mental health, child and family studies, sociology, speech and hearing.
Specific experience with the target population may be required to work with Children, Health Home Plus or Adult Home Plus members.
EXPERIENCE REQUIRED / LANGUAGE PREFERENCE:
Experience working in interdisciplinary teams; experience providing care management or care coordination in a medical or behavioral health environment; experience working with the chronically ill.
Fluency in a second language such as Spanish, Russian, or Creole (preferred, but not required)
COMPUTER SKILLS REQUIRED:
Intermediate computer proficiency
VISUAL AND MANUAL DEXTERITY:
The candidate should be able to read paper and electronic documents and perform significant data entry into various computer programs
Manual dexterity and hand-eye coordination to conduct significant data entry and record keeping required.
WORK ENVIRONMENT / PHYSICAL EFFORT:
The work environment varies from office-based interaction with co-workers and members (20-40% of the time) to serving members in their homes and in other community settings (e.g. hospitals, clinics, benefit offices) 60%-80% of the time. While the offices of the are accessible in accordance with the ADA, the sites to which staff may need to travel may or may not be.
To perform the essential functions of this job the candidate must be able to travel within New York City carrying equipment such as a notebook, forms, laptop, mobile hotspot and cell phone weighing up to approximately 10 pounds.
To perform the essential functions of this job, the candidate is routinely required to sit (60% of the time) and stand (20% of the time), and travel to and from appointments using varied public and private transportation options (20% of the time).
Risks/hazards associated with the position are those which may be encountered travelling around New York City.