Care Coordination Specialist

Housing Works Community Healthcare; New York (NY); On-site; USD 50,000 - 55,000; Full time

Benefits offered by this job

Healthcare plans

PTO up to 30 days

Educational benefit

Job summary

Housing Works Community Healthcare in New York is seeking a Care Coordination Specialist to provide comprehensive medical case management for Primary Care patients. You will enroll patients, coordinate referrals, document interactions, and manage essential EMR processes, collaborating closely with clinical and support staff to ensure coordinated, high-quality care.

The ideal candidate has 1–2 years in a medical setting, proficiency with Microsoft Office and EMR systems, and a commitment to

Qualifications

• Associate’s Degree required; Bachelor’s Degree preferred.
• 1–2 years of experience in a medical setting is preferred.
• Spanish-speaking ability preferred.

Responsibilities

• Coordinate enrollment of uninsured patients and assist with ADAP applications.
• Document hospitalizations and coordinate discharge planning with care teams.
• Enter and manage patient data in the EMR and maintain accurate records.
• Coordinate referrals, ensure PCP assignment, and track outcomes.
• Support patient registration, scheduling, and advocacy efforts.

Skills

PRAPARE assessments

HIPAA regulations

Microsoft Office

EMR familiarity

Spanish speaking

Organizational skills

Advocacy for homelessness/HIV/AIDS

Education

Associate’s Degree

Bachelor’s Degree preferred

Tools

eCW

eIcare

EMR systems

Job description

Compensation Range:

$50,000-$55,000/annually commensurate with experience

Benefits:

We have three comprehensive healthcare plans to choose from based on your priorities and budget. Housing Works covers most of the plan; you pay a portion, based on your salary. Staff begins accruing PTO immediately for a total of up to 30 days earned in the first year. We offer employees an educational benefit. This money is available for tuition loan reimbursement, tuition costs, and text books.

Overview:

The Care Coordination Specialist (CCS) is a vital member of our healthcare team, responsible for delivering comprehensive medical case management services to all Primary Care patients. The role is designed to ensure that patients receive coordinated, high-quality care from the moment they interact with our services. This position involves working collaboratively with clinical and support staff to manage patient enrollments, streamline referrals, document key patient interactions, and manage essential administrative processes within our Electronic Medical Record (EMR) system. The successful candidate will demonstrate exceptional organizational skills, clinical understanding, and a commitment to enhancing patient outcomes while supporting our mission to advocate for those affected by homelessness, substance use, and HIV/AIDS.

Key Responsibilities:

Patient Enrollment & Insurance Assistance:

• Coordinate the enrollment of uninsured patients with insurance programs, including facilitating ADAP (AIDS Drug Assistance Program) applications.
• Assist patients with various insurance authorization processes and paperwork.

Medical Case Management:

• Document hospitalizations and schedule discharge appointments as needed.
• Collaborate with internal clinical programs and support staff to monitor and communicate regarding client progress and referrals.
• Own care coordination tasks unless otherwise designated.

Communication & Documentation:

• Document significant issues discussed during morning huddles and telephone encounters in clinical meetings.
• Collaborate with the Nurse Manager (NM/RN) to create pre-huddle sheets that outline patient needs for provider follow-up.
• Ensure proper documentation and data entry in the EMR related to referrals and patient records.
• Actively participate in Morning Huddles and regular medical staff meetings, including Quality Improvement sessions.
• Provide coverage for the Patient Access Specialist (PAS) as needed.

Referral & Records Management:

• Coordinate all aspects of referrals initiated by health center providers, ensuring that:
• Clients are aligned with a Primary Care Provider (PCP) before referral processing.
• Appropriate structured data fields are updated within the referral tracking module in the EMR.
• Patients receive all necessary paperwork for appointments, labs, x-rays, or other prescribed services.
• Referral outcomes are tracked and communicated to the ordering provider.
• Insurance authorizations are obtained when necessary.
• Complete medical records requests and upload relevant documents into patient charts.
• Oversee the distribution of UND gift cards to eligible clients and accurately record receipt details in systems such as eCW and eIcare.

General Support & Advocacy:

• Provide professional assistance during patient registration and the scheduling of appointments.
• Support advocacy efforts aimed at addressing the challenges of homelessness and AIDS.
• Demonstrate commitment to the Housing Works Core values: Membership, All In, Stronger Together, and High Performance.
• Manage other duties as assigned by the Practice Manager, especially in a fast-paced environment with competing priorities.
• Understand and meet the needs of both internal and external customers by delivering effective service and escalating issues when required.

Job Requirements:

• Associate’s Degree required; Bachelor’s Degree preferred.
• One to two years of experience in a medical setting or related field is preferred.

Clinical and Organizational Skills:

• Strong organizational and clinical skills are essential.
• Proficiency in performing PRAPARE (Social Determinates of Health) assessments, recognizing medical emergencies, and alerting appropriate personnel.
• Proficient with Microsoft Office.
• Familiarity with EMR systems is preferred.

Knowledge:

• In-depth understanding of HIV/AIDS, case management practices, and entitlement programs.
• Strong commitment to the principles of harm reduction.
• Comprehensive knowledge of HIPAA regulations regarding requests for medical documents is required.
• Spanish-speaking preferred.
• Preference for individuals with experiencing working in a community-based setting, particularly with patients who are LGTBQIA+, and/or have experienced homelessness, substance use, and/or mental health challenges

Availability:

- Ability to work evenings.

Housing Works was founded in 1990; With a long-term commitment to AIDS advocacy. Housing Works established New York State’s first harm reduction-based, OASAS-licensed outpatient drug treatment program. Other services include Health Home care management, behavioral health, and syringe exchange programs. A pioneer in the social entrepreneurship movement, Housing Works operates 10 high-end thrift shops in Manhattan and Brooklyn and a much-loved Bookstore Cafe in Soho. For more information, visit www.housingworks.org

Housing Works fights for funding and legislation to ensure that all people living with HIV/AIDS have access to quality housing, healthcare, HIV prevention, and treatment, among other lifesaving services.

Housing Works provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements. Housing Works complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. Housing Works also does not request prior salary information during the hiring process. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws.For further information, please review the Know Your Rights notice from the Department of Labor.