Health Home Care Manager (Downstate, NY / Field-based)

FreedomCare•Brooklyn, NY

7d•Onsite

About The Position

FreedomCare is seeking a Health Home Care Manager for its Care Management team. This field-based role requires frequent travel to patients’ homes in Brooklyn and Queens, New York. The Care Manager engages potentially eligible patients, obtains enrollment consents, and, after enrollment, works with each patient’s care team to complete a comprehensive assessment and patient-centered care plan and coordinate services based on that plan. The role serves chronically ill patients and supports them in reaching care plan goals through referrals, access assistance, connections to local resources, and coordination with healthcare providers and other members of the care team. The position also includes crisis intervention, home visits, and maintaining confidential, standards-compliant records. FreedomCare describes its values as service, empathy, and availability; ownership; integrity; and a positive, can-do approach. The company states that it is committed to an inclusive workplace and offers competitive compensation, medical benefits, retirement plans, wellness programs, company events, and ongoing learning opportunities. The base pay range at the commencement of the first year is $24.00–$26.00 per hour; compensation decisions may depend on factors including skills, relevant experience, education, location, and licensure or certifications.

Requirements

Associate’s degree.
Two years of Care Management experience.
Ability to travel to at least two boroughs: Brooklyn and Queens.
Ability to travel in the field to accompany patients to appointments and meet patients in person when needed.
Strong working knowledge of local community resources.
Demonstrated ability to work with data reporting, documentation, and outcomes.
Strong communication and assessment skills, including the ability to relate to patients, families, and community care providers and handle rapidly changing crisis situations.
Ability to manage high-volume caseloads.
Empathy and compassion for underserved populations.
Experience navigating multiple data management systems, such as Salesforce.

Nice To Haves

Bachelor’s degree.
Spanish bilingual ability is strongly preferred.
Ability to travel to all five boroughs in the New York City area.
Access to a vehicle is strongly preferred.

Responsibilities

Screen patients for Health Home functional scale eligibility.
Conduct initial Health Home assessments and reassessments covering medical, mental health, substance use, financial, housing, and other support needs.
Collaborate with medical providers and patients to develop, implement, and coordinate compliant care plans for patients with chronic diseases and other conditions.
Document care plan outcomes.
Provide direct care management services to a caseload of chronically ill patients and help them achieve care plan goals.
Facilitate referrals, address access issues, connect patients to local resources, and develop 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 services in accordance with Health Home standards.
Maintain patient confidentiality.
Outreach to and engage potentially eligible patients and obtain appropriate consents for enrollment in the Health Home Care Management Program.