Children's Health Home Care Manager

Position Type / Expected Hours

40 hours weekly. Flexible to the needs of the program.

Qualifications

• Bachelor’s degree with two (2) years relevant experience, or NYS licensure and registration as a Registered Nurse, or a Master’s degree with one (1) year relevant experience.
• Strong written, verbal, and organizational skills.
• Computer skills necessary.
• Travel within the tri‑county area frequently.
• Authorized to work in the United States.

Summary / Objective

The Care Manager conducts and schedules assessments, referrals, advocacy and support, counseling, and education of patients, enrollees, and care team members, ensuring patients receive quality services to maintain optimum healthcare needs without barriers. Responsibilities include outreach and engagement to formally enroll referred individuals into the care management program, conducting assessments, evaluating needs, establishing and maintaining care plans, and maintaining referrals for enrollees. The role also assures supports are in place, including peer and family contacts.

Essential Functions

• Develop interim Plan of Care based on preliminary clinical information and assigned level, identifying immediate linkages and services.
• Ensure all initial linkages are established and maintained.
• Collaborate with all service providers and establish a team communication plan.
• Monitor goals continuously and ensure team communication.
• Verify that the care plan aligns with health home policies and procedures.
• Consult with family members and social supports to maintain support consistency.
• Advocate for additional services and linkages as appropriate.
• Maintain current care‑management documentation and activity information within the required health information technology (HIT) system.
• Enter and maintain progress notes related to the Plan of Care.
• Attend quarterly regional meetings for the Central New York Health Home Network (CNYHHN).
• Participate in monthly conference calls with CNYHHN providers.
• Engage families in the outreach process once a referral is received.
• Ensure compliance with CNYHHN policies and procedures.
• Complete all required online and in‑person training from CNYHHN and the agency.
• Participate in agency committee(s) as assigned.
• Attend and satisfactorily complete all required in‑services.
• Provide rotating after‑hours on‑call coverage outside regular working hours, with additional compensation per organizational policy.

Competencies

• Ethical conduct
• Time management
• Organizational skills
• Project management
• Personal effectiveness / credibility

Supervisory Responsibility

None

Work Environment

This role operates in a professional office environment and routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets, and fax machines.

Physical Demands

The employee is regularly required to talk or hear, frequently required to stand, walk, lift, use hands to finger, handle or feel, and reach with hands and arms.

Other Duties

This job description is not designed to cover a comprehensive listing of all activities, duties, or responsibilities required of the employee. Duties, responsibilities, and activities may change at any time with or without notice.