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Health Home Care Manager

2 months ago


Ossining, United States Open Door Family Medical Center Full time

**Responsibilities**:

- Outreach individuals referred to the program and engage them into the program.
- Conduct assessments to identify individualized needs related to psychosocial well-being, physical health and the social determinants of health.
- Based on the findings from the assessment, collaborate with enrollees to set goals and develop a care plan; monitor goal achievement and revise the care plan.
- Utilize Motivational Interviewing and other techniques to assist in goal setting and achievement.
- Coordinate and arrange for the provision of medical, behavioral health, social and other relevant services, including appointment scheduling, appointment reminders and transportation booking.
- Accompany enrollees to appointments both on
- and off-site.
- Collaborate with family members/caregivers as well as internal and external service providers.
- Model and coach enrollees on medical/behavioral service navigation with the aim of empowering enrollees to become independent, effective health care consumers.
- Conduct home visits to provide services to enrollees and assess the enrollees’ living environment.
- Support enrollees in adherence to treatment recommendations from medical and behavioral health providers.
- Provide health education to assist with enrollees’ understanding of physical and behavioral health conditions and treatment and link enrollees with evidence
- and research-based resources.
- Discuss advance directives and health care proxies with enrollees and their families or caregivers.
- Retain enrollees in care over time.
- Maintain a caseload of 50 individuals.
- Complete all documentation as required including data entry into New York State data portal and Open Door’s electronic medical record.

**Qualifications**:

- **Bachelor’s Degree and relevant work experience. Degree in Social Work or social sciences preferred; other degrees will be considered.**:

- **Fluent in English and Spanish is required.**:

- Minimum two years’ experience in healthcare and/or social services settings; case/care management experience a plus.
- Must have valid NYS driving license and daily access to car.
- Must have valid New York State driver’s license and daily access to a car.
- Strong written and verbal communications skills.
- Passionate about providing high quality care to low-income, under-served individuals and those lacking access to health care.
- Patient-centric, engaging and empathetic with strong active listening skills.
- Comfortable providing direct patient care to adults of all ages with an array of chronic medical and behavioral health needs.
- Competence working with culturally diverse client and staff populations.
- Able to navigate healthcare and community settings as well as enrollees’ natural settings (i.e. place of residence).
- Collaborative and effective when working with a team of service providers.
- Responsive and comfortable in a fast-paced, high-accountability environment.
- Highly organized, self-directed, able to multi-task and be flexible.
- Effective problem solver, exhibiting excellent judgment and the ability to prioritize.

Open Door offers its employees a stimulating, diverse and team-based work environment with comprehensive benefits including medical, dental, vision and life insurance, flexible spending accounts, 403(b) and a matching 401(k), generous paid time off, onsite Wellness facilities, and educational assistance. At Open Door, we enjoy working in a team-based, patient-centered environment and value the benefits of a diversified workplace that values our patients and the communities we serve.

Open Door is an Equal Opportunity Employer.

Pay: $25.00 - $28.00 per hour

Expected hours: 37.5 per week

**Benefits**:

- 401(k)
- 401(k) matching
- Dental insurance
- Employee assistance program
- Flexible spending account
- Health insurance
- Life insurance
- Paid time off
- Parental leave
- Referral program
- Tuition reimbursement
- Vision insurance

Schedule:

- 8 hour shift
- Monday to Friday

Work setting:

- Outpatient

**Education**:

- Bachelor's (preferred)

**Language**:

- Spanish/English fluently (required)

License/Certification:

- NYS Drivers License and daily access to car (required)

Work Location: In person