High-Risk Care Coordination Specialist

Northwell Health; Manhasset (NY); On-site; USD 65,000 - 90,000; Full time

Job summary

Northwell Health in Queens is seeking a Care Management professional to coordinate and participate in Care Management services for families and caregivers within the Health Home Plus program. The role supports high-need populations through individualized care planning and effective collaboration with a broad care network.

Responsibilities include conducting motivational interviewing, coordinating panels to improve follow-up, and ensuring smooth transitions from hospital to community settings,

Qualifications

• High School Diploma or equivalent required.
• 1–3 years of relevant experience, required.
• CASAC credential with two years of experience or a Bachelor's degree with three years of experience serving the SMI/SED population is highly preferred.
• NYS driver’s license strongly 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 patients lost to care or non-compliant with follow-up.
• Develops, maintains, and adjusts care plans addressing medical and social barriers to accessing care.
• Acts as a liaison between hospitals, primary care providers, specialists, and community resources for patient-centered care coordination.
• Identifies high-risk populations and others due for preventive or chronic care services.
• Tracks patients discharged from inpatient or ER and follows up as needed.

Skills

Motivational interviewing

Panel management

Care coordination

Team-based communication

Outreach

Education

Bachelor's degree or higher

CASAC credential

High School Diploma or equivalent

NYS Driver's License preferred

Job description

Northwell Health in Queens is seeking a Care Management professional to coordinate and participate in Care Management services for families and caregivers within the Health Home Plus program. The role supports high-need populations through individualized care planning and effective collaboration with a broad care network.

Responsibilities include conducting motivational interviewing, coordinating panels to improve follow-up, and ensuring smooth transitions from hospital to community settings,