Job Title
Care Manager
Job Location
Remote (Must be based in NY/NJ)
Job Type
Full-time
Work Setup
Hybrid, remote
Salary Range
$50k - $60k
Job Description
The Care Manager delivers the six core services in a person‑centered manner to meet the needs of individuals, OPWDD outcomes, People First Transformation objectives, and State requirements. Responsibilities include referral and linkage to benefits and services, and conducting in‑person visits ranging from monthly to bi‑annually depending on individual needs.
Responsibilities
- Complete a Comprehensive Assessment for each individual, identifying medical, mental health, chemical dependency, developmental disability, and social service needs.
- Develop a Life Plan with the individual, involving family, collaterals, and service providers; all parties agree on goals, interventions, and timelines.
- Manage a caseload of up to a weight of 20 (generally 35–40 members), with visits scheduled monthly, quarterly, or bi‑annually as required.
- Care Coordination and Health Promotion:
- Engage individuals in treatment adherence and monitor needs.
- Coordinate all aspects of care and develop relationships between the care‑planning team.
- Update the Life Plan and initiate changes as needed.
- Ensure timely access to medical/behavioral health appointments and link individuals to resources.
- Collaborate with internal and external interdisciplinary teams.
- Implement recommendations from internal clinical teams and participate in post‑hospital/rehabilitation discharge.
- Comprehensive Transitional Care:
- Assist individuals with transitions between levels of care or after critical events (hospital, school, rehabilitation).
- Follow up post‑discharge and provide crisis support.
- Use Health Information Technology to facilitate collaboration among providers.
- Individual and Family Support:
- Communicate and share information with individuals and representatives, ensuring the Life Plan reflects preferences.
- Utilize peer supports and support groups to increase family awareness.
- Provide monthly contact and engagement with all members/families.
- Follow up to achieve member satisfaction with TCC and external services.
- Referral to community and social support services:
- Identify available resources and actively manage referrals, engagement, and follow‑up.
- Include community‑based and other social support services in the Life Plan to achieve goals.
- Use of HIT link services:
- Meet HIT standards in delivering core services and the Life Plan.
- Maintain written documentation of service delivery in the Electronic Health Record while practicing HIPAA and privacy regulations.
- Additional Responsibilities:
- Monitor and assist individuals with benefits (Food Stamps, Medicaid, SSI).
- Support individuals with P&P related to schooling and other relevant issues.
- Report any incident of abuse, neglect, or maltreatment immediately.
- Other duties as assigned/requested.
Qualifications
Required Education, Experience, and Licenses:
- Bachelor’s degree with two years of relevant experience, OR
- Registered Nurse license with two years of relevant experience (may include any employment experience, not limited to case management/service coordination duties), OR
- Master’s degree with one year of relevant experience.
- MSC Service Coordinators prior to July 1, 2018 are “grandfathered” to facilitate continuity of care.
Specific Knowledge, Skills, and Abilities:
- Excellent interpersonal skills, including conflict management and knowledge of de‑escalation techniques.
- Advanced ability to effectively communicate verbally and in writing.
- Computer software skills, particularly Microsoft Suite.
- Ability to organize, schedule, and use time efficiently.
- Capability to analyze situations accurately, prioritize, and take effective action.
EEO Statement
We are an EEOC Employer.