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Syracuse

    Care Manager - Syracuse, United States - Coordinated Care Services, Inc.

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    Description


    The Care Manager's primary function is to work in partnership with individuals with I/DD to coordinate care and services needed to assist individuals achieve optimal health, wellness, and life goals.

    The Care Manager is responsible to provide Health Home core services including comprehensive care management, care coordination and health promotion, comprehensive transitional care, individual and family support, referral to community and social support services, and use of Health Information Technology to link services.

    Care Managers will provide all services with a person-centered approach and that aligns with NYS OPWDD Valued Outcomes.

    Essential Job Functions:
    Conduct comprehensive assessments to identify an individual's clinical and psychosocial needs, choices, and preferences for services
    Assess and address health and safety issues as well as barriers to care and treatment including social determinants of health
    Collaborate with interdisciplinary team and incorporate input into comprehensive assessment and Life Plan
    Develop and maintain a person-centered Life Plan that coordinates and integrates an individual's clinical and non-clinical healthcare related needs and services
    Monitor and facilitate implementation of and provide updates as needed to the Life Plan
    Incorporate health promotion and support opportunities for individuals to achieve and maintain optimal health and wellbeing
    Coordinate and ensure access to chronic disease management
    Facilitate referrals to clinical and community resources, including planning, referrals, and follow-up for transitional care
    Coordinate and provide access to long-term care supports and services
    Engage families and natural supports into the care coordination process
    Ensure all individuals and families receive services that are culturally and linguistically appropriate
    Advocate on behalf of the individual
    Promote self-advocacy and the ability to self-direct
    Use Health Information Technology for documentation, to link services, and facilitate communication among care coordination team
    Secure all health records and other protected information with the highest regard to confidentiality and HIPAA laws and regulations
    Maintain compliance with all state and federal laws and regulations, Medicaid compliance, and PCC policies and procedures
    Document all services and maintain appropriate records following all established documentation procedures
    Represent PCC on workgroups, committees, advisory groups or networks as assigned
    Participate in opportunities for continued training and education
    Perform all other duties relevant to the position as requested.
    Knowledge, Skills, and Abilities
    Ability to act quickly, assess and act accordingly in crisis situations
    Basic technology skills and understanding of health records
    Knowledge of ethical and professional responsibilities and boundaries
    Demonstrate professional work habits including dependability, time management, independence and responsibility
    Some positions may require bi-lingual skills

    Education and Experience:
    Bachelor's degree with two years of relevant experience

    OR
    A license as a Registered Nurse with two years of relevant experience, which can include any employment experience and is not limited to case management/service coordination duties

    OR
    A Master's degree with one year of relevant experience.

    Physical Requirements/Working Conditions:
    Ability to sit/stand throughout day to accomplish job
    Ability to enter data, notes, and other documentation into a computer.
    Must be able to travel throughout covered territories in Upstate NY as needed.

    • Reasonable accommodations may be made to the extent required under applicable law to enable individuals with disabilities to perform the essential functions of this position.

    Corporate Qualifications/Expectations:
    Adhere to all Prime Care Coordination policies and procedures.
    Adhere to the Agency Mission, Vision, Shared Values, and Customer Service Standards.
    Attend mandatory education and training modules as scheduled; obtain and maintain required certifications.
    Maintain all required certifications/training by State regulations and PCC policy
    Act as a professional representative of PCC in regard to appearance, behavior, temperament, communication, language, and dress.

    Prime Care Coordination is an Equal Opportunity Employer, and as such affirms the right of every person to participate in all aspects of employment without regard to gender, race, color, religion, national origin, ancestry, age, marital status, sexual orientation, pregnancy, disability, citizenship, military or veteran status, gender expression and/or identity, or any other status or characteristic protected by federal, state, or local law.

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