Integrated Support Care Manager

Sun River Health•Poughkeepsie, NY

About The Position

Sun River Health is a Federally Qualified, non-profit health center serving communities in several New York counties. The organization provides comprehensive primary, preventive, and behavioral health services regardless of insurance status or ability to pay, with a focus on underserved and vulnerable communities. The full-time Integrated Support Care Manager works at the Poughkeepsie and Amenia locations and provides integrated care management using a harm-reduction approach to address psychosocial barriers to care. The role includes care coordination, psychoeducation, casework counseling, connections to community supports, referral follow-up, and communication with patients and care teams. The manager attends ongoing training addressing patient needs related to HIV, substance use, hepatitis C, mental health, and chronic conditions, and performs duties in compliance with applicable systems and job-specific standards.

Requirements

High school diploma or GED.
Experience in health or social services.
Knowledge of the geographic community served and available resources.
Ability to communicate in English, orally and in writing.
Ability to communicate in Spanish, orally and in writing, is preferred.
Ability to collaborate with colleagues to maintain high-quality standards and achieve client satisfaction.
Strong verbal and written communication skills, initiative, enthusiasm, and creativity.
Ability to organize work effectively, accept and use guidance, and work cooperatively.
Flexibility, cultural sensitivity, and ability to maintain confidentiality.
Emotional, mental, and physical capability to perform the duties and commitment to achieving goals.
Knowledge of stages of change, substance use disorders, HIV, HCV, and other co-occurring conditions.

Nice To Haves

Associate degree.
Certified Recovery Peer Advocate (CRPA).
Ability to communicate in Spanish, orally and in writing.

Responsibilities

Complete care management intakes and support medication-assisted treatment (MAT) addiction programs.
Develop, implement, and monitor individualized patient care plans.
Establish linkages to internal and external support services, refer patients, and follow up on referrals.
Complete patient Recovery Support Plans and Crisis Plans, as appropriate.
Communicate and collaborate effectively with patients and interdisciplinary care teams, including providers.
Provide Naloxone training to patients and staff.
Conduct or support HIV testing and ensure linkage to appropriate services and follow-up.
Participate in case conferencing with care teams.
Maintain accurate, current case records and complete required documentation and reports in a timely manner.
Empower and educate patients and link them to HIV, HCV, and STI testing and treatment, PrEP, substance use services, and primary care.
Participate in ongoing training to enhance professional skills and patient care.
Support quality improvement initiatives and perform other duties as assigned.