Track and maintain a system of patient medical appointments, labs and other critical time-sensitive activities required to maintain the client’s health.Ĭomplete all program standards documentation as required. Maintain Electronic Health Record and all required electronic data. Meet and maintain program productivity standards. Provide crisis intervention when required. Maintain on-going contact with interdisciplinary team of medical providers, acting as team leader for the client’s care coordination activities. Refer and follow-up on referrals for clients to ensure medical stabilization.Ĭlosely coordinate all hospital discharges with hospital or acute care settings to ensure thorough implementation of the discharge plan, and follow-up on recommendations from the ER, hospital or acute care facility.Īssist clients and their families in resolving barriers to obtaining medical services.Įscort clients to appointments when necessary to increase medical adherence. The care plans must clearly identify and integrate the entire continuum of care, addressing all needs identified by the comprehensive assessment.Īdvocate and assist clients in obtaining and maintaining entitlements and housing.Īssist and support clients in treatment adherence recommendations, including prevention, wellness, recovery, and care transitions. Utilizes electronic health records to effectively coordinate care for the client.Įngage new HH clients into service and maintain engagement in care coordination.Ĭonduct intake and comprehensive health assessments/reassessments, identifying mental health, chemical dependency and social service needs.ĭevelop comprehensive, measurable, goal-oriented care plans in collaboration with interdisciplinary team of external providers. Provides proactive care management, evidenced through provision of core services and development of a care plan which leads toward client centered outcomes. Care Managers will be assigned a county office as their primary office location.Įngages and assesses HH clients with the goal of coordinating care, and utilizing a shared care plan in which the client’s needs are accurately expressed.Ĭompletes documentation in a clear and comprehensive manner which is in compliance with DOH, Health Home and Agency standards and requirements for quality care and billing.Ĭoordinates with pertinent service providers to ensure that all clients’ needs are being addressed. Care Managers will have a dedicated caseload of clients and the caseload will vary depending on intensity of client need. Under the supervision of a Program Supervisor or Senior Program Supervisor, the Health Home (HH) Care Manager is responsible for providing the core components of care coordination to low, intermediate and high need individuals with chronic illnesses including mental health conditions and HIV. For more than fifty years, Cornerstone has been responsive to meeting the needs of the communities in which we serve with a continued emphasis on the underserved and those without access to health care regardless of race, economic status, age, sex, sexual orientation or disability. HVCS a Division of Cornerstone Family Healthcare is actively recruiting for a Health Homes Care Manager to join our growing Health Homes team, based out of Newburgh, NY.Ĭompetitive salaries I Health Benefits I Retirement plan I Paid Time Off I Sick Time I Flexible Spending I Dependent Care I Paid HolidaysĬornerstone Family Healthcare is a non-profit Federally Qualified Health Center with a mission to provide high quality, comprehensive, primary and preventative health care services in an environment of caring, dignity and respect to all people regardless of their ability to pay.
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