Care Management Coordinator - NYC/BX

Northwell; Melville (NY); On-site; USD 60,000 - 90,000; Full time

Job summary

Northwell is seeking a Care Management professional to coordinate care for high-risk patients and collaborate with primary care teams to improve follow-up and reduce gaps in care.

The role emphasizes patient-centered care, liaison work among hospitals and community resources, and outreach across settings to ensure timely follow-up and appropriate access to services.

Qualifications

• 1-3 years of relevant experience required.
• Bachelor's or Master's degree strongly preferred.
• NYS Driver's License strongly preferred.
• Bilingual Spanish preferred.

Responsibilities

• Uses patient-centered motivational interviewing techniques to build rapport and help patients improve their health.
• Supports the primary care team by providing panel management to decrease patient loss to care and improve follow-up.
• Acts as a liaison between hospitals, primary care providers, specialists, and community resources for patient-centered care coordination.
• Identifies and tracks high-risk populations and those due for preventive or chronic care services.
• Identifies patients discharged from inpatient or ED and ensures follow-up actions.
• Performs outreach in primary care sites, homes, hospitals, and neighborhoods to close gaps in care.

Skills

Motivational interviewing

Care coordination

Panel management

Bilingual Spanish

Education

Bachelor's degree in a related field

Master's degree preferred

Job description

Job Description

Coordinates and participates in activities related to Care Management services to family members and caregivers.

Job Responsibility

• Utilizes patient-centered motivational interviewing techniques to build rapport and help patients improve their health.
• Supports the primary care team by providing panel management to decrease the number of patients lost to care, non-compliant in follow up care or disconnected from primary care. Participates in the development, maintenance, and adjustment of individualized care plans for high-risk patients that address both medical and social barriers to accessing care.
• Acts as a professional liaison between hospitals, primary care providers, specialists, and community resources on behalf of patients to ensure patient-centered care coordination.
• Identifies and tracks special populations, including high-risk patients and other populations due for preventive or chronic care services.
• Identifies and tracks patients discharged from the inpatient service or the emergency department.
• Uses team-based communication strategies to close the loop on referrals, hospital follow-ups and any outstanding items identified in the patient's care plan. Performs outreach activities in primary care sites, homes, hospitals, and neighborhoods.

Job Qualification

• High School Diploma or equivalent required.
• 1-3 years of relevant experience, required.
• Bachelor's or Master's degree in relevant field strongly preferred.
• Health home or care management experience strongly preferred.
• NYS Driver's License strongly preferred.
• Bilingual Spanish, preferred.
• *Additional Salary Detail The salary range and/or hourly rate listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future.When determining a team member's base salary and/or rate, several factors may be considered as applicable (e.g., location, specialty, service line, years of relevant experience, education, credentials, negotiated contracts, budget and internal equity).