Care Management Navigator for High-Risk Patients

Northwell Health; Manhasset (NY); On-site; USD 70,000 - 95,000; Full time

Job summary

Northwell Health is seeking a Care Management professional to support Health Home Plus services for defined populations with SMI (severe mental illness). You will coordinate care, conduct patient-centered outreach, and collaborate with the primary care team to keep patients engaged.

Responsibilities include developing care plans, acting as a liaison among hospitals, PCPs, specialists, and community resources, and identifying high-risk patients for preventive services.

Qualifications

• High School Diploma or equivalent required.
• 1-3 years of relevant experience, required.
• Bachelor's or Master's degree strongly preferred.
• CASAC credential and two years of relevant experience OR higher degree with two/three years in Health Home care management for SMI/SED population preferred.

Responsibilities

• Coordinate and participate in Care Management services for families and caregivers.
• Provide panel management to reduce missed follow-ups and non-compliance with care.
• Develop, maintain, and adjust individualized care plans addressing medical and social barriers.
• Act as liaison between hospitals, PCPs, specialists, and community resources for patient-centered care.
• Identify and track high-risk patients and those due for preventive or chronic care services.
• Execute outreach in primary care sites, homes, hospitals, and neighborhoods.

Skills

Motivational interviewing

Care coordination

Panel management

Liaison

Education

High school diploma

Bachelor's or Master's degree

CASAC credential

Job description

Northwell Health is seeking a Care Management professional to support Health Home Plus services for defined populations with SMI (severe mental illness). You will coordinate care, conduct patient-centered outreach, and collaborate with the primary care team to keep patients engaged.

Responsibilities include developing care plans, acting as a liaison among hospitals, PCPs, specialists, and community resources, and identifying high-risk patients for preventive services.