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Care Management Specialist

2 months ago

Staten Island, New York, United States Northwell Health Full time
Job Summary

Northwell Health At Home is seeking a skilled Care Management Coordinator to join our team. As a Care Management Coordinator, you will play a critical role in coordinating and participating in activities related to Care Management services to family members and caregivers.

Key Responsibilities
  • Utilize patient-centered motivational interviewing techniques to build rapport and help patients improve their health.
  • Support 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.
  • Participate in the development, maintenance, and adjustment of individualized care plans for high-risk patients that address both medical and social barriers to accessing care.
  • Act as a professional liaison between hospitals, primary care providers, specialists, and community resources on behalf of patients to ensure patient-centered care coordination.
  • Identify and track special populations, including high-risk patients and other populations due for preventive or chronic care services.
  • Identify and track patients discharged from the inpatient service or the emergency department.
  • Use team-based communication strategies to close the loop on referrals, hospital follow-ups and any outstanding items identified in the patient's care plan.
  • Perform outreach activities in primary care sites, homes, hospitals, and neighborhoods.
Requirements
  • High School Diploma or equivalent required.
  • 1-3 years of relevant experience, required.
  • Bachelor's or Master's degree in a relevant field strongly preferred.
  • Health home or care management experience strongly preferred.
  • NYS Driver's License strongly preferred.
About Northwell Health At Home

At Northwell Health At Home, our team members take pride in building meaningful relationships with their patients because they realize the power it has to transform lives. As the region's largest integrated home care organization, we deliver award-winning care in ways that make a difference to our patients and their families.