OverviewConducts assessments and develops client/member centered plans of care. Provides coordination of services between the varying providers for clients / members with complex psychiatric, substance use, and/or co-morbid medical conditions. Ensures access and linkage to the full array of necessary physical and behavioral health services and other community based services to address social determinants of health. Coordinates effective communication between all providers for the ultimate benefit of the client/member. Works under general direction.
What We Provide
Referral bonus opportunities
Generous paid time off (PTO), starting at 20 days of paid time off and 9 company holidays
Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life and Disability
Employer-matched 401k retirement saving program
Personal and financial wellness programs
Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care and commuter transit program
Generous tuition reimbursement for qualifying degrees
Opportunities for professional growth and career advancement and CEU credits
What You Will Do
- Utilizes approved assessments to identify clients/members needs and develop initial and ongoing clinical plan of care.
- Updates plan at specified intervals, and as needed based on changes in client/member condition or circumstances.
- Performs and maintains effective care management for assigned caseload of clients/members. Tracks and monitors progress; maintains detailed, accurate and timely progress notes and other documentation.
- Develops inventory of resources that meet the clients/members needs as identified in the assessment.
- Provides linkage, coordination with, referral to and follow-up with appropriate service providers and managed care plans. Facilitates periodic case record reviews and case conferences with all providers serving the clients/members.
- Works collaboratively with team members to provide outreach for and engage resistant/hard to reach clients/members to accept program services.
- Provides information and assistance through advocacy and education to clients/members and family on availability and eligibility of entitlements and community services. Arranges transportation and accompanies clients/members to appointments as necessary.
- Participates in initial and ongoing trainings as necessary to maintain and enhance care management skills.
- Maintains updated case records in program EMR. Maintains case records in accordance with program policies/procedures, VNS Health standards and regulatory requirements.
- Participates and consults with team supervisor in case conferences, staff meetings, and discharge planning meetings to determine if client/member requires an alternate level of care or is appropriate for discharge.
- Maintains appropriate documentation and standards for all specialized caseloads such as HH+, AOT, Non Medicaid, HARP cases and other special populations
- Participates in special projects and performs other duties as assigned.
About the Program
Health Home Care Management
Health Home Care Management provides long-term care coordination and case management services for adults living with serious mental illness, substance use disorders, HIV/AIDS, and other complex chronic conditions. The program helps individuals navigate healthcare systems, access community resources, improve health outcomes, and achieve greater stability through coordinated, person-centered care.
Why Join This Program: Work across healthcare and community systems to help high-risk individuals improve their health, independence, and quality of life.
QualificationsLicenses and Certifications: Valid NYS ID or NYS driver’s license required. NYS Community Mental Health Assessment instrument and HCBS training completion preferredMust complete necessary training to administer NYS Eligibility Assessment for HCBS service in the UAS system within 60 days of start date.Child and Adolescent Needs and Strengths New York (CANS) certification preferredMust complete necessary training to administer the CANS NY assessment in the UAS system within 60 days of start date.
Education: Bachelor's Degree in a human services or related field required Enrollment/attendance in Master’s degree program in human services or related field preferred
Work Experience: Minimum of two years of experience providing direct services to clients/members with Serious Mental Illness (SMI), developmental disabilities, substance use disorders and/or chronic medical conditions client required with a Bachelor’s degree; minimum of one year of experience with a Master’s degree.Effective oral/written/interpersonal communication skills requiredBilingual skills may be required as determined by operational needs.Basic computer skills required
Pay RangeUSD $23.17 - USD $28.96 /Hr.
About UsVNS Health has been committed to meeting the needs of New Yorkers for over 130 years. We’re one of the largest nonprofit home- and community-based health care organizations in the country, and today, more than 11,500 team members work together to make a difference in the lives of more than 99,000 patients and members on any given day.
