Bilingual (Spanish/English speaking) Care Coordinator, Brooklyn

Major Duties

• Obtains required Care Management enrollment consents from the individual or legal guardian
• Completes initial and ongoing needs assessments (Child and Adolescent Needs and Strengths; CANS) to determine the individuals most appropriate level of care management.
• Responsible for the overall management of the patients Individualized Plan of Care.
• Carefully coordinate the enrollees provision of services including as per their acuity level.
• Support adherence to treatment recommendations.
• Maintain and evaluate a patients needs, including prevention, wellness, medical, mental health, care transitions, and social and community services where appropriate.
• Meet client contact requirements (keeping in mind that caseloads may be blended).
• Meet Care Management documentation requirements in a timely and accurate manner by effectively utilizing designated Care Management Portal (Medicaid Analytics Performance Portal; MAPP) and Electronic Health Records (EHRs) as needed.
• Function as an advocate for clients within the agency and external service providers.
• Promote wellness and prevention by linking enrollees with resources and services based on their individual needs and preferences.
• Help clients to obtain and maintain public benefits necessary to gain health care services, including Medicaid and cash assistance eligibility, Social Security, SNAP, housing, legal services, employment and training supports, and others.
• Effectively communicate and share information with the individual and their families and other caregivers with appropriate consideration for language, literacy and cultural preferences.
• Conduct care planning meetings/conferences and serve as an interdisciplinary team member to effectively provide/coordinate comprehensive and holistic care.
• Actively manage appropriate referrals, access, engagement, follow-up and coordination of services.
• In the event of hospital admissions, actively engage in the discharge planning process ensuring that the patient has all recommended post discharge services in place prior to discharge.
• Attend and participate in ongoing staff development trainings to enhance skills needed to effectively meet the demands of the Care Manager position.
• Ensure that child has periodic evaluations and follow up treatment for dental, vision and hearing care, following Medicaid EPSDT guidelines.

Qualifications

• Education and/or credential requirements are determined by children's acuity level and requires one or more of the following:
• Bachelor of Arts or Science degree with two years experience required
• Bilingual Spanish/English speaking candidates are highly encouraged to apply
• Must have previous experience as a Case Planner; Care Coordinator; Case Manager and/or Case Worker in a social service setting
• Relevant expertise and experience in serving children and families in child welfare, developmental disabilities, mental health, healthcare and/or other systems as well as those receiving preventive services
• Care Coordinators serving high acuity enrollees will be required to have demonstrated knowledge and understanding of the needs of such children and their families as evidenced by additional years of experience, education, or training
• Care Coordinators assigned to children who have medical fragility must have extensive experience in coordinating their care
• Experience providing service coordination and information, linkages, and referrals for community-based services.