Care Manager, Health Home & Child Welfare Services
Overview
Care Manager owns coordination of services for children and families within MercyFirst Health Home at scale in Brooklyn NY. Works with a multidisciplinary team to develop and implement a patient centered Plan of Care for enrollees with complex needs. The role is embedded in a community based, trauma informed setting and emphasizes family driven, youth guided services. You will collaborate with caregivers, providers and external partners to ensure timely access, appropriate referrals and continuity of care.
What You'll Do10
- 1Build and maintain a comprehensive Plan of Care for each enrollee and track interventions to achieve outcomes
- 2Design and conduct initial and ongoing needs assessments (CANS) to determine level of care management
- 3Own the overall management of the Individualized Plan of Care and ensure timely documentation in MAPP and EHR systems
- 4Coordinate with clinicians, providers and community resources to support treatment adherence and access to benefits
- 5Advocate for clients within the agency and with external partners to align goals and services
- 6Educate families on chronic conditions, preventive care, immunizations and screenings
- 7Identify and link social determinants of health resources including Medicaid, SNAP and housing
- 8Conduct care planning meetings as an interdisciplinary team to coordinate holistic care
- 9Ensure timely post discharge planning and follow up services during hospital transitions
- 10Participate in ongoing trainings and ensure periodic evaluations for EPSDT compliant care
Requirements7
- 1Bachelor's in social work or Associate in related field
- 2Bi-Lingual Spanish
- 32 years of related work experience serving children and families in child welfare developmental disabilities mental health healthcare or related areas
- 4Experience providing service coordination, referrals and linkages to community based services
- 5Excellent verbal and written communication skills
- 6Proficiency in Microsoft Word and Outlook
- 7Ability to engage with clients and demonstrate cultural humility and commitment to mission
Salary Insight
$50 - $56k per year
Location
Required Skills
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