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The Fortune Society
Unit: Care Management Unit
Reports to: Sr. Director, Care Management Unit
Status: Full-Time; Regular; Non-Exempt
Location: Bronx and Long Island City
Days/Hours: 5 Days/Week
Date Prepared: February 28, 2018
The Fortune Society has immediate availability for the newly-created position of Health Home Care Navigator serving the Bronx communities. This is a growth position for the right candidate who possesses strong Health Home Care Navigation experience. Under the immediate supervision of the Bronx Care Manager s/he will help ensure the successful implementation of the care coordination efforts of our Health Home activities within the Bronx. S/he will utilize health information technology to monitor and track pertinent client health information and will support the Care Manager by participating in client intake assessments and client outreach and engagement. Field visits are required.
Our ideal candidate is fully versed in the NY State policies and procedures as they relate to Health Home care navigation duties, and has a strong working knowledge of the major database systems and health portals affiliated with Health Homes. S/he will work both independently and collaboratively to help build and coordinate the activities of the Bronx care team, serving criminally justice involved patients with complex medical and/or mental health conditions, many of whom are transient or undomiciled.
Fortune’s Care Management Unit (CMU) employs a truly unique approach to health home care management. We empower our workers to identify and execute creative, meaningful pathways to providing health care coordination services for high utilization Medicaid clients with criminal justice histories who have chronic health and mental health conditions.
Essential Duties and Responsibilities:
• Responsible for assisting the Care Manager and other Care Management Team members in implementing clients’ individualized Plans of Care;
• Responsible for alerting or bringing important follow-up items to the Care Manager’s attention;
• Meets with enrolled and/or potential Care Management clients in the field and communicates the benefits of Care Management effectively;
• Ensures Care Management Team members receive client alerts (e.g., ER visits, admissions, discharges);
• Provides reminder phone calls for all appointments;
• Performs outreach when clients have not kept important appointments;
• Performs phone outreach between in-person visits to check on self-care, medication refills, and receipt of test results and to schedule in-person visits and follow-up tests;
• Aids in identifying primary care physicians and/or psychiatrists and provides ongoing coordination as needed;
• Ensures clients are seen by appropriate providers within 5 days of an inpatient psychiatric stay and within 7 days of an inpatient medical stay;
• Identifies and contacts eligible Care Management participants, through face-to-face outreach, email, phone;
• Schedules initial appointments with eligible Care Management participants, and follows-up with reminders, including phone and email contact;
• Builds relationships with local community leaders and attends network partner events to actively market and promote the program to target populations;
• Works with on-site organizations to coordinate referrals for eligible participants;
• Attends staff meetings and trainings and provides program updates to the Care Manager;
• Provides information in a culturally and linguistically appropriate manner to the population being served; and
• Performs additional responsibilities as needed.
• Must have at least one year of recent experience as a Health Home Care Navigator;
• Associate’s degree strongly preferred; High School diploma or GED with a minimum of 1 yr. care management experience accepted;
• Must have strong working knowledge of the Bronx, including health and social services available to clients living in this area;
• Proficiency with MAPP, ePACES and other NY State databases, and able to navigate multiple Health Home database platforms;
• MS Office, Word and Excel proficiency a must;
• Must have professional, client-centered demeanor with an ability to operate in a fast paced environment;
• Bi-lingual English/Spanish strongly preferred in order to best suit the clients who reside in this area; and
• Ability to perform additional responsibilities as needed
Travel Requirements – Will require travel throughout the Bronx, as well as to Fortune’s locations in Harlem and Long Island City. Additional travel to clients’ locations when necessary to ensure continued progress of Plan of Care. MetroCard transportation is provided to staff for all client-related activities.
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The responsibilities and requirements listed are representative of the knowledge, skills, minimum education, training, licensing, experience and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the job.
The Fortune Society is an Equal Opportunity Employer. All qualified applicants will be afforded equal employment opportunities without discrimination because of conviction history, race, religion/creed, color, national origin, sex, age, disability, sexual orientation, gender identity, military status, predisposing genetic characteristics, victim of domestic violence status or marital status.
must apply online:
Posted on 03/02/18; CVMHA ID #11922