Community Health Worker, Sayville Project - Stony Brook University

Mark Lane

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Mark Lane

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Description

Community Health Worker, Sayville Project

Required Qualifications (as evidenced by an attached resume):
Bachelor's degree (foreign equivalent or higher) in Social Work or a related discipline. Relevant care management, human services and/or social work experience.

Must have, keep and maintain the appropriate valid NYS Driver's License; have a motor vehicle record which is free from major violations or a pattern of repeat violations.

(**Out-of-State Applicants, see "Special Notes").


Preferred Qualifications:

One plus years (1+) of relevant care management, human services and/or social work experience.

A Master's degree (foreign equivalent or higher) in Social Work or a related discipline with relevant mental health/social work experience in an approved social work/human services (Internship program may be substituted for work experience).


Brief Description of Duties:


The Community Health Worker provides outreach, assessment and supportive care management services to adult persons with psychiatric disabilities and other chronic physical and behavioral health conditions that live in Suffolk County.

This includes the provision of telephonic and field-based outreach services to potential Health Home enrollees and the assessment and enrollment of individuals in the Sayville Project's Medicaid Health Home Program.

The Community Health Worker also aids the care management staff by assisting enrolled clients in the development and fulfillment of their health and recovery plan and other life goals; accessing necessary health, behavioral health, and other social services and supports; and compiling and linking clients to needed community resources.

The overall goals of the Health Home Program are the improvement of health outcomes for persons with serious and chronic medical and behavioral health conditions through care coordination.


  • Perform an initial assessment of prospective clients to determine eligibility for Health Home Care Management Services. Conduct all functions related to enrollment of the member in the Health Home Program (including consents, SBIRT screens, advance directives, etc.). These assessments are primarily performed in the field in the individual's home environment.
  • Perform Health Home services and support enrolled clients in the development and fulfillment of life and recovery goals. Assist clients to improve health outcomes, and to reduce the use of unnecessary ER and inpatient utilization. Provide health education and resources to assist clients to increase health literacy and independent control over their lives.
  • Complete required client and program record keeping and documentation in accordance with professional standards and the guidelines and regulations stipulated by the NYS DOH Health Home Initiative, the NYS OMH, Suffolk County Division of Community Mental Hygiene and the Office of Compliance and Audit for SBU. Develop a comprehensive knowledge of Health Home services, member eligibility criteria and the Health Home enrollment process. Adhere to privacy, confidentiality and HIPAA standards and regulations in all dealings with clients and with regard to documentation of work.
  • Provide outreach services to identified persons with psychiatric disabilities and other chronic behavioral and physical health conditions in accordance with agency/SBU, NYS OMH, NYS DOH, Health Home, Suffolk County DMH, Medicaid MCO and Medicaid guidelines and regulations, policies and procedures. These services are provided to prospective clients in the field which requires use of one's own vehicle for travel to/from appointments. Prospective clients are identified by the NYS DOH (and the approved Medicaid MCO Plans) by way of rosters sent to the Health Home.
  • Perform telephonic and communitybased foot outreach to prospective health home clients in the communities and towns of Suffolk County.
  • Develop an understanding of client rights and entitlements, community, behavioral and physical health, other resources and referral and grievance procedures and develop practices in accordance with the advocacy/empowerment theoretical model, operating from a clientcentered, strengths and recoverybased social work practice orientation.
  • Attend required and recommended staff, inservice and webbased training, meetings and activities and participate in critical reflection of one's practice and provide feedback and support to staff and colleagues
  • Participate in outreach activities to potential and former clients. Provide health education to the client community and take leadership in implementing communitybased programs and initiatives and advocacyoriented projects, to organize and educate others on health and recoveryoriented issues and obstacles faced by the client population.
  • Other duties or projects as assigned as appropriate to rank and departmental mission and in specific those necessary for the success of the agencies Care Management and Health Home Programs.
**Special No

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