Case Manager, Health Homes (Rochester, NY / Field Based) Sign on Bonus $500.00

FreedomCare•Buffalo, NY

2d•Hybrid

About The Position

FreedomCare is a healthcare company dedicated to revolutionizing the home care industry. We support patients by ensuring they have the power to choose a caregiver for their home care needs. Our mission spans coast to coast, supporting patients across the U.S. We are looking for a Case Manager for our Care Management team in upstate NY. This position requires frequent travel to patients’ homes in Buffalo, NY and surrounding areas within Erie County. The Case Manager will work to outreach and engage potentially eligible patients and obtain appropriate consents to enroll the patient in the Health Home Care Management Program. Once the patient is enrolled, the Case Manager will work collaboratively with the patient's care team to complete a comprehensive assessment and patient centered care plan, and to coordinate care based on the care plan.

Requirements

Ability to travel in the field to accompany patients to appointments and meet patients in person when needed
1+ year of health homes, HARP or case management experience (required)
Strong working knowledge of local community resources
Demonstrated ability to work with data reporting, documentation, and outcomes
Strong communication and assessment skills; the ability to relate to patients, their families, and community care providers, along with ability to handle rapidly changing crisis situations
Ability to manage high volume caseloads
Able to express empathy and compassion for the underserved
Experience navigating several data management systems, such as Salesforce
Minimum associate's degree

Nice To Haves

Bilingual Spanish, strongly preferred
Master's degree is a plus
3+ years of Health Homes experience
3+ years of HARP experience

Responsibilities

Screen for Health Home functional scale eligibility, conduct initial Health Homes assessments and reassessments of patient needs, including medical, mental health, substance use, financial, housing, and additional support needs
Collaborate with the medical providers and patients to develop, implement, and coordinate Health Homes compliant care plans for patients with chronic diseases, such as diabetes, asthma, congestive heart failure, hypertension, mental health conditions, substance use, and more and document care plan outcomes
Provide direct service to a caseload of chronically ill patients and help them achieve their care plan goals by facilitating referrals, addressing access issues, connecting them to local resources, and developing relationships with healthcare providers
Coordinate patient services and care with pharmacies, insurance companies, hospital discharge planning, family caregivers, and other providers
Provide crisis intervention when needed
Conduct home visits and maintain patient contact and documentation of all services in accordance with Health Homes standards
Maintain patient confidentiality at all times