Health Home Care Manager (LMSW)
New York, NY
Title: Health Home Care Manager (LMSW)
Location: New York City, NY
Occupational Category: Allied Health
Description: Hiring a Health Home Care Manager (LMSW). The Health Home Care Manager (LMSW) ensures that patients with targeted chronic medical conditions, including pediatric asthma, coronary heart disease/hypertension, adult diabetes, HIV, and mental illness, have access to and obtain needed medical, behavioral health and social services to optimize their health status. The Health Home Care Manager (LMSW) will provide care coordination, health education and health promotion services to patients. As the Health Home Care Manager (LMSW), the individual will develop a comprehensive care plan to address barriers and expected health outcomes and self-management goals. The Health Home Care Manager (LMSW) will inform and assist patients with enrolling in relevant benefits and entitlement programs and health insurance programs
- Assess patients for patient care coordination and care management services including health home enrollment through intake, meetings with the patient, the patient s family and/or care givers, and review of relevant documentation to develop a care plan; obtain input on the patient s ability to self-care, identify psychosocial stressors and barriers to care including health insurance, housing, financial assistance, learning difficulties and other disabilities.
- Develop a comprehensive care plan to address barriers and expected health outcomes and self-management goals.
- Schedule patient appointments with providers and, as necessary, provide referrals and appointment follow-up with service and medical providers.
- Inform and assist patients with enrolling in relevant benefits and entitlement programs and health insurance programs through the New York State Health Marketplace.
- Conduct intensive outreach to patients that have disengaged or are at risk of disengaging from care, and individuals whose psychosocial stressors are limiting their success in achieving healthy outcomes.
- Provide home, hospital, or community site visits and escort patients to medical and non-medical appointments as indicated in the patient s care plan, and as approved by staff Monitor and/or Supervisor.
- LMSW Certification required.
- Minimum of 2 years of relevant experience working in a medical setting with a population with chronic conditions.
- Bilingual Spanish/English.
- Database management experience.