POSITION SUMMARY

The Care Manager conducts and schedules assessments, referrals, advocacy and supports, counseling, education of patients and enrollees and care team members assuring the patient receives quality services to maintain optimum healthcare needs without barriers.

ESSENTIAL RESPONSIBILITIES:

Activities include but are not limited to the following:

• Conducts assessments, evaluates needs, establishes and maintains care plan and maintains referrals for enrollees. Assures supports are in place inclusive of peer and family contacts.

• Develops Interim Plan of Care based on preliminary clinical information and assigned level that will identify linkages and services immediately required, based on information received from referral sources if applicable.

• Ensures all initial linkages are established and maintained.

• Collaborates with all services providers and establishes team communication plan.

• Monitors goals on a continuing basis and that team is communicating.

• Monitors that care plan is relevant to Health Home/ Care Management Agency policies and procedures.

• Consults with family members and social supports to maintain support consistency.

• Advocates for additional services and linkages as appropriate.

• Provides technical assistance to staff.

• Facilitates and communicates decisions in care management programming.

• Coordinates and leads staff meetings.

• Facilitate case coordination and participate in activities as part of the treatment team meeting.

• Conduct orientation and training of new staff & acts as a resource for staff.

• Coordinate resources and material distribution; assist in scheduling of staff training and in services; arrange transportation for individuals as required to maintain case load.

• Maintains current care management documentation and information regarding care management activities within the required health IT system.

• Litmos trainings completed within designated time frame by CNYHHN.

• After hours on call rotation as designated by Program Manager.

• Maintains roster consisting of no more than 45 points per NYS regulation capacity.

• Conducts visits with each members as per Care Management Agency policy.

• Abides by all Care Management Agency/ CNYHHN policies and procedures.

• Perform all other duties as directed by the Program Manager.

QUALIFICATIONS/EDUCATION/EXPERIENCE

• Bachelor’s degree in psychology, sociology, human services or related field.

• 1-2 years’ experience in Human Services, primarily Geriatric.

• Basic Computer Skills (Windows, Outlook, Adobe Acrobat, Word, Excel).

• This position does have regular and substantial unsupervised or unrestricted physical contact with individuals receiving services and is required by law to be fingerprinted for a criminal history record check under OMH (Office of Mental Health).

• Travel is required. Must have a valid NYS Driver’s License and reliable transportation.

• Must possess the ability to make independent decisions when circumstances are warranted.

WORK ENVIRONMENT/HAZARDS

• Job related tasks do not involve exposure or potential exposure to blood, body fluids, or tissue and Category I tasks are not a condition of employment.

• OSHA Exposure Category III

PHYSICAL DEMANDS

• The employee must have full sight and hearing with fluency in the English language. While performing the duties of this job, the employee is regularly required to talk or hear.

• The employee frequently is required to stand, walk and sit. Must be able to sit for long periods of time.

• Constantly operates a computer and other office productivity machinery, such as a copy machine, scanner, computer printer, etc.

• The employee must occasionally lift and/or move up to 25 pounds.

• Certain deadlines and unanticipated developments may require work during evenings, weekends;

• The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the position without compromising work-flow and efficiency.

WORK CONTACT GROUP

All staff, individuals at sites, visitors, family members, vendors, various regulatory and professional agencies.