Care Coordinator - Adolescent Health

Mount Sinai Health System•New York, NY

About The Position

The Mount Sinai Adolescent Health Center works to reduce racial, social, and economic barriers to health care and wellness for young people by providing high-quality, comprehensive, integrated, and confidential services. The Care Coordinator provides trauma-informed services within a health equity framework to at-risk adolescents ages 10–26 and their families in an integrated medical and mental health primary care setting. The role assesses patient needs, particularly access to concrete support such as housing, food, legal services, and educational support, and partners with patients to identify solutions and develop measurable, attainable, individualized care goals. The coordinator supports whole-person care by integrating behavioral, medical, and social services addressing mental health, substance use, psychosocial challenges, and health-related social needs. The role may also engage families and caregivers to support follow-through and healthy adolescent development, while promoting culturally and developmentally appropriate care.

Requirements

Bachelor’s degree, such as a BSW or BA.
Experience in adolescent behavioral health, case management, primary care, or community health.
Excellent engagement, assessment, and collaboration skills, with the ability to work flexibly in a high-volume, fast-paced setting.
Knowledge of adolescent development, family engagement, advocacy, mental health, and social determinants of health.
Strong communication, care coordination, and documentation skills.
Knowledge and practice of Motivational Interviewing to engage adolescents and families, support behavior change, and promote self-efficacy.
Experience working with underserved youth populations.

Nice To Haves

Experience working in integrated or collaborative care models.
Bilingual English-Spanish skills.

Responsibilities

Complete assigned patient referrals and screening to identify needs related to food, housing, legal services, and educational support.
Facilitate scheduling of dental and optical services at the Adolescent Health Center, based on needs identified during assessment or by the primary care team.
Coordinate referrals to specialty behavioral health services, substance use treatment, and community resources.
Collaborate with primary care providers, behavioral health clinicians, psychiatric consultants, and community resources.
Identify and address social determinants of health affecting adolescents, including housing instability, food insecurity, transportation, and safety concerns.
Monitor patient progress, adjust care plans with the primary care team, and promote resilience and healthy coping strategies.
Engage caregivers and families in care planning and education while respecting confidentiality and adolescent consent laws.
Participate in case reviews, interdisciplinary care team meetings, and quality improvement initiatives.
Document screenings, assessments, and outcomes accurately in the EHR.
Track follow-up appointments and support continuity of care.
Attend Epic Scheduling Training.