Senior Care Coordinator - Health Homes

CAMBA•New York, NY

13d•$58,367 - $58,367•Hybrid

About The Position

CAMBA is a community organization dedicated to building an inclusive New York City by providing a wide range of integrated programs in Education & Youth Development, Family Support, Job Training & Employment Support Services, Health, Housing, and Legal Services. CAMBA's Health Home program is an innovative care management model aimed at improving health outcomes for individuals with severe mental illness and complex chronic illnesses. This program utilizes coordinated networks of providers and health information technology to ensure clients receive primary medical care, prevent hospitalizations, and reduce the length of existing hospital stays. CAMBA's involvement in health homes positions it at the forefront of significant system-wide changes impacting human services.

Requirements

Bachelor’s degree (B.A. or B.S.W) and two years of relevant experience, or
Bachelor's degree (B.A. or B.S.W.) and one year of experience within CAMBA's Health Link program.
Bi-lingual English with Spanish or Haitian-Creole preferred.

Nice To Haves

Evening or weekend availability may be required for special projects, audits, or early field work.

Responsibilities

Aid individuals and/or families requiring social service assistance.
Comply with all Federal, State, City, and CAMBA security and privacy policies for protecting health information.
Locate and utilize appropriate community resources for clients.
Practice Universal Precautions/Standard Protocol & Procedures.
Evaluate actual living conditions of clients through home visits.
Maintain professional relationships with clients and client confidentiality.
Review documentation establishing client eligibility for programs and make file copies (e.g., Medicaid status, HIV status confirmation).
Assist clients in completing CAMBA intake applications and forms.
Create and maintain client files.
Manage a caseload of approximately 55 clients.
Conduct initial intake or assessment of clients and their families, and perform periodic reassessments.
Interview and assess applicants for services, develop service plans and goals, and support clients in implementing these plans.
Conduct case conferences prior to finalizing assessments/reassessments.
Follow up with clients and referral organizations regarding client contact and progress.
Work with clients to overcome barriers to their goals, assist them in self-advocacy, and move toward self-sufficiency.
Recommend and implement strategies to encourage client participation.
Monitor client progress toward service plan goals through regular telephone contact and/or face-to-face home and office visits, documenting outcomes and progress notes.
Recommend closing cases when clients have achieved primary goals and maintained stability, have not participated in the process, or have become ineligible for services.
Provide required information for weekly, monthly, quarterly, and annual reports.
Act as a client liaison/advocate with outside organizations regarding education, healthcare, housing, legal issues, entitlements, etc.
Escort clients to appointments (educational, medical, social service, etc.).
Follow up with clients for a period after successful goal completion to ensure stability.
Plan, coordinate, and facilitate social/peer support events, including group facilitation for clients.
Prepare marketing materials for the program.
Input client data and progress information into an automated database.
Reach out to and market the program to the community to recruit clients.
Prescreen clients over the telephone for eligibility and schedule intake appointments.
Assist clients in completing applications for benefits and entitlements, and may process applications on their behalf.
Perform other duties as assigned.