Care Coordinator

Bond Health; New York (NY); Hybrid; USD 50,000 - 60,000; Full time

Benefits offered by this job

Mostly remote

Job summary

Bond Health in Warren County is seeking Care Managers for a full-time, mostly remote role. You will deliver the six core services in a person-centered way to meet the needs of individuals, achieve valued outcomes, and comply with state requirements, with visits ranging from monthly to bi-annually as needed.

Responsibilities cover comprehensive care management, coordination, transitional care, family support, referrals, and HIT usage with HIPAA-compliant record-keeping.

Qualifications

• Bachelor’s degree with two years of relevant experience, or Master’s with one year.
• MSC Service Coordinators prior to July 1, 2018 are “grandfathered” to facilitate continuity of care.
• Strong interpersonal, communication, and de-escalation skills.

Responsibilities

• Provide comprehensive, person-centered Care Management services focusing on the 6 core services.
• Coordinate care, link to benefits, and schedule visits.
• Assist transitions between levels of care and post-discharge follow-up.
• Maintain HIT documentation and HIPAA compliance.
• Monitor benefits like Food Stamps, Medicaid, and SSI.

Skills

Interpersonal skills

Conflict-management

De-escalation

Verbal communication

Written communication

Time management

Microsoft Office

Health IT

Education

Bachelor’s degree +2 years

Master’s degree +1 year

Tools

Electronic Health Records

HIT systems

Job description

Care Managers needed in Warren County
Full time mostly remote position!

Job Overview:
The role of the Care Manager is to deliver the 6 core services in a person-centered manner in order to meet the needs of the individual, the OPWDD valued outcomes, the objectives of the People First Transformation, and the State requirements. The Care Manager provides referral and linkage to benefits and services, and in-person visits with members ranging from monthly to bi-annually dependent on the need of each member.
Essential Responsibilities:
Provide comprehensive, person-centered Care Management services focusing on the 6 core services:
1. Comprehensive Care Management
-Complete a Comprehensive Assessment for each individual that identifies medical, mental health, chemical dependency, developmental disability, and social service need
-Develop a Life Plan with the individual; include family, collaterals, and service providers in fulfillment of the Life Plan; parties should agree with the goals, interventions, and timeframes
-Caseload size up to a weight of 20, generally 35-40 members, but may vary
-Conduct face-to-face visits as required (Monthly, Quarterly, or Bi-Annually dependent on regulatory requirement and individual needs of each individual)
2. Care Coordination and Health Promotion
-Engage the individual in the adherence to treatment recommendations, monitor and evaluate individual's needs; coordinate all aspects of the individual's care; develop relationship between the care planning team
-Review and update the Life Plan with the care planning team; initiate changes in care
-Ensure timely access to appointments for individuals to medical/behavioral health care services; link individuals with resources
-Collaboration with both internal and external interdisciplinary teams.
-Instituting recommendations from internal clinical teams
-Involvement in post-hospital/rehabilitation discharge
3. Comprehensive Transitional Care
-Assist the individual to transition between levels of care, or after critical events, such as: hospital, school, rehabilitation facility, etc., follow up in a timely manner post discharge, support individual during crisis events
-Use Health Information Technology to facilitate collaboration among all providers
4. Individual and Family Support
-Communicate and share information with individuals and their family/representative, ensure that the Life Plan reflects the individual's and their family/representative's preferences
-Utilize peer supports, support groups to increase family/representative's awareness
-Provide monthly contact and engagement with all members/families
-Follow up to strive for complete member satisfaction with TCC and external services
5. Referral to community and social support services
-Identify available resources and actively manage referrals, engagement, and follow-up
-Ensure that the Life Plan includes community-based and other social support services that respond to the individual's needs and preferences and contribute to achieve the individual's goals
6. Use of HIT link services
-Meet the HIT standards in the delivery of core services and the Life Plan, as described in the manual
-Maintain written documentation of service delivery and individuals' information on the Electronic Health Record System while practicing all HIPAA and Privacy regulations
Additional Responsibilities:
-Monitoring/Assisting individuals with maintaining benefits (Food Stamps, Medicaid, and SSI)
-Support individuals with P&P related to schooling, and any relevant issues
-Report any incident of abuse, neglect, or maltreatment immediately
-Other duties as assigned/requested
Specific Knowledge, Skills, and Abilities:
-Excellent interpersonal skills, including conflict-management and knowledge of de-escalation techniques
-Advanced ability to effectively communicate in both verbal and written manner
-Computer software skills, particularly skills with Microsoft Suite
-Ability to organize, schedule, and utilize time well
-Capability to analyze situations accurately, prioritize, and take effective action
Required Education, Experience, and Licenses:
-A Bachelor's degree with two years of relevant experience, OR
-A Master's degree with one year of relevant experience
-MSC Service Coordinators prior to July 1, 2018 are “grandfathered” to facilitate continuity of care
Salary: $50,000-$60,000 per year.