Social Care Manager-Capital Region

Healthy Alliance • City of Schenectady, NY

just now • Hybrid

About The Position

At Healthy Alliance, our purpose is to improve health and empower communities facing barriers. Our network brings together organizations to coordinate and collaborate so that all communities have reliable access to the resources they need, aiming for better health for all New Yorkers. Designated as the Social Care Network (SCN) Lead Entity for the Capital Region, Central NY, and North Country under New York’s 1115 Waiver Amendment’s SCN & Health-Related Social Needs (HRSN) Program, Healthy Alliance is responsible for ensuring a seamless process for screening, navigation, and delivery of services like food, housing, and transportation to thousands of Medicaid Members. The organization has been recognized as a Best Place to Work by Albany Business Review (2019-2024) and Modern Healthcare (2021-2025), fostering a culture of autonomy, mastery, and purpose. The Social Care Manager serves as the direct point of contact for Members with ongoing Health-Related Social Needs (HRSNs), conducting eligibility assessments for Managed Medicaid Members and developing Social Care Plans. This role is based in the Capital Region.

Requirements

• Associate degree in health, social services, or related field preferred. Equivalent work experience in a related field may be considered in lieu of degree requirements.
• Minimum of 5+ years related experience in a clinical, non-profit, or managed-care organization environment preferred.
• Extensive knowledge and understanding of health equity, social drivers of health, and social care data.
• Excellent communication and presentation skills.
• Ability to build collaborative working relationships with others inside and outside the organization through cooperation, mutual respect and capacity to inspire and motivate others.
• Thrive working with multiple systems and processes.
• Extremely detailed-oriented and capable of multitasking.
• Proven record of hitting key metrics, defining effective data-driven network development strategies, and problem-solving.
• Proficient computer skills and willingness to learn additional software applications.
• Demonstrated ability to thrive in a demanding environment.
• Performs all work in accordance with Healthy Alliance core competencies and values.
• Member-Centered Care Coordination and Critical Thinking: Actively listen to Members, apply critical thinking, and independently assess needs to determine appropriate next steps, referrals, and resources.
• Time Management and Workload Prioritization: Effectively manage multiple referrals, prioritize tasks, meet documentation timelines, and maintain accuracy in a high-volume environment.
• Workflow Navigation and Process Adherence: Navigate internal workflows confidently, locate information efficiently, apply processes accurately, and adapt to operational changes.
• Communication and Interpersonal Effectiveness: Communicate clearly and empathetically with Members and teams, remain calm under pressure, and handle escalations professionally.

Nice To Haves

• Associate degree in health, social services, or related field preferred.
• Minimum of 5+ years related experience in a clinical, non-profit, or managed-care organization environment preferred.
• Experience using translation services preferred.

Responsibilities

• Manage incoming referrals for enhanced HRSN care management to support successful and timely connections for community members.
• Provide longitudinal care management for Members receiving one or more enhanced HRSN services.
• Utilize the Electronic Provider Assisted Claim Entry System/Medicaid Eligibility Verification System (ePACES/MEVS) and other data sources to confirm Medicaid enrollment and HRSN screening status, as well as existing care team management.
• Conduct and document outreach to community members in alignment with required frequency, modality, and timeframe.
• Manage Member consent and attestation as required throughout the screening, assessment, and care management process.
• Conduct HRSN screening using the Accountable Health Communities (AHC) screening tool to assess Member HRSNs.
• Conduct eligibility assessments to determine Member eligibility for enhanced HRSN services and refer Members to eligible programs and services to include enhanced HRSN services and/or existing federal, state, and local resources.
• Develop Social Care Plans that include a summary of Member needs, eligibility, and services to which they are referred.
• Ensure referrals are acted upon by HRSN service providers within required timeframes and redirect referrals as necessary to support service connection. Document progress notes and action taken with each referral, as detailed in the Network Standards and Quality Program.
• Update the Social Care Plan throughout service provision in collaboration with the Member and service provider to reflect strategies and interventions for meeting identified HRSNs.
• Monitor and manage eligibility status changes in collaboration with Eligibility Specialists and Enhanced HRSN service providers.
• Confirm service delivery completion and Member needs have been addressed satisfactorily and support the transition to additional resources.
• Demonstrate ability to use various technology platforms to ensure successful and timely referral connections are made.
• Maintain effective communication with internal team members, community members, and partner organizations to ensure overall coordination of care.
• Collaborate with Performance team to report partner effectiveness and efficiency regarding referral response and service delivery and escalate community member service issues in a timely manner.
• Regularly use data and data tools to report referral patterns and trends to the Referral Coordination Manager.
• Share detailed feedback on successes and challenges of the role with the Referral Coordination Manager and continually look for opportunities to enhance and simplify the community member experience.
• Effectively work in a hybrid work environment. Some local travel may be required for meetings, community events, and other job-related responsibilities.
• Demonstrate commitment to the values of diversity, equity, and inclusion.
• Maintain current knowledge and understanding of Medicaid and local transformation, including New York Health Equity Reform (NYHER) 1115 Wavier Amendment, Waiver programs, Triple Aim, and value-based purchasing (VBP).
• Perform other responsibilities and duties as assigned.

Benefits

• Competitive compensation package
• Comprehensive insurance benefits available the 1st of the month after hire, including but not limited to medical, dental and vision, group short-term disability and life insurance with buy-up options, flexible spending and HSA company-contributed accounts, and more
• 401K with a company match
• Unlimited paid time off after 90 days of employment
• Company-sponsored training and certification opportunities
• Hybrid work environment and people-first workplace
• A workplace that values safety, respect, employee engagement, recognition, and diversity
• Salary range: $52,950-$60,892 per year, commensurate with experience

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree