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

FreedomCare•Brooklyn, NY

1d•Hybrid

About The Position

FreedomCare is a healthcare company dedicated to revolutionizing the home care industry. We support patients by empowering them to choose their own caregivers for in-home care. Our mission is coast to coast, supporting patients across the U.S. We are looking for a Health Home Care Manager to join our Care Management team. This is a field-based position requiring frequent travel to patients' homes in New York City, specifically within Brooklyn, Queens, Bronx, and Manhattan.

Requirements

Bachelor's Degree is required.
2 years of Care Management experience.
Must be able to travel to a minimum of 2 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; the ability to relate to patients, their families, and community care providers, along with the 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.

Nice To Haves

Master's Degree is a plus.
Bilingual Spanish strongly preferred.
Ability to travel throughout multiple boroughs in the NYC area.
Access to a vehicle is strongly preferred.

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 medical providers and patients to develop, implement, and coordinate Health Homes compliant care plans for patients with chronic diseases.
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.
Outreach and engage potentially eligible patients and obtain appropriate consents to enroll the patient in the Health Home Care Management Program.
Complete a comprehensive assessment and patient-centered care plan for enrolled patients.
Coordinate care based on the care plan.