The Care Manager’s role will involve community outreach. Coordinating participant’s needs before and after their move from street to home, enhancing their daily living skills, accompaniment to appointments, and advocating on their behalf when faced with discrimination or healthcare inequities. Member choice, harm reduction, non-coercion, flexibility, and person-centered care are essential elements of the CBO/SOS program model and should be front and center of the care delivered by the Care Manager.
Job Responsibilities:
· Persistent and assertive outreach and engagement using strength-based approaches beginning either at known “hang-outs” or “Hot spots”, during an inpatient hospital admission or emergency department visit;
Continuously assess the health and social needs of participants through CBO/SOS’s· conversational and observational assessments and formalized risk assessments tools for those identified as being at high risk;
· Participate in hospital discharge planning meetings to identify the best community resources for returning patients;
Collects and reports data, as required and work with team leader, data analyst and other CBO/SOS teams to use data to inform future care delivery;
· Once housed work with participants and their housing providers to resolve clinical issues that are impacting on the participant’s ability manage, and retain supportive housing;
· Foster relationship with community provides to ensure that recipients are connected with appropriate services as they transition back into the community;
· Appointment navigation including accompaniment to appointments, travel training, reengagement in community care, and addressing barriers to care;
· Review documentation and conduct comprehensive psychosocial assessments to determine the medical, psychiatric, housing and other social needs in the community;
· Obtain historical and collateral information from multiple sources to support participants behavioral and physical health needs;
· Monitor, evaluate and record participants progress with respect to care plan goals;
· Attend and participate in team meetings and supervisory sessions.
· Perform other related duties as assigned.
Minimum Education and Experience Requirements: Bachelor's degree or higher, preferable in psychology, social work, sociology, or related field or be a New York State Licensed Practical Nurse (LPN). Care Management work experience in a social service agency, preferable serving a behavioral health population. Four years of past work case management work experience may be considered in lieu of Bachelor's degree. This position requires travel throughout the 3 counties we serve; Chenango, Broome and Otsego.
Job Type: Full-time
Pay: $24.00 - $26.00 per hour
Expected hours: 40 per week
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Employee assistance program
- Health insurance
- Life insurance
- Paid time off
- Retirement plan
- Vision insurance
Schedule:
- 8 hour shift
- Monday to Friday
- On call
- Weekends as needed
License/Certification:
- Driver's License (Preferred)
Security clearance:
Willingness to travel:
Work Location: In person