Care Manager

Key Responsibilities

• 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 individual’s most appropriate level of care management
• Develops and manages the patient’s Individualized Plan of Care
• Maintains oversight of a patient’s needs, including prevention, wellness, medical, mental health, care transitions, and social and community services
• Maintains monthly contact and billing requirements
• Maintains Care Management documentation in a timely and accurate manner using designated portals and EHRs
• Fulfills the role of an advocate for clients within the agency and external service providers
• Promotes wellness and prevention by linking enrollees with resources and services based on their individual needs and preferences
• Trains and educates clients on care of chronic conditions, immunization, screening, and other preventive interventions
• Affords clients access to public benefits such as Medicaid, cash assistance, Social Security, SNAP, housing, legal services, employment and training supports, and others
• Communicates and shares information with clients and families in a way that considers language, literacy, and cultural preferences
• Participates in care planning meetings and conferences, functioning as an interdisciplinary team member to provide comprehensive and holistic care
• Identifies and manages community-based resources, making appropriate referrals, ensuring access, engagement, follow-up, and coordination of services
• Engages in the discharge planning process for hospital admissions, ensuring the patient has all recommended post-discharge services in place prior to discharge
• Attends and participates in ongoing staff development trainings to enhance skills needed to effectively meet the demands of the Care Manager position
• Ensures periodic evaluations and follow-up treatment for dental, vision, and hearing care, following Medicaid EPSDT guidelines

Required Qualifications

• Bachelor’s degree in Arts or Science with two years’ experience
• Bilingual Spanish is a plus
• Relevant expertise and experience in serving children and families in child welfare, developmental disabilities, mental health, healthcare, and other systems as well as those receiving preventive services
• Experience providing service coordination and information, linkages, and referrals for community-based services
• Excellent writing, communication, and organizational skills
• A passion for serving children and families with special needs
• Ability to work in-person in New York City (NYC)
• Ability to travel to other Rising Ground Sites (if required)
• Ability to travel in the community and do visits