Ambulatory care coordinator jobs in Syracuse, NY

Troy Center is hiring an in-person MDS Coordinator in Troy, NY. Completing accurate assessments, MDS & care plans as assigned Initiating care plans and supporting activities as assigned Creating and distributing monthly care plan calendars in a timely fashion Maintaining & updating all care plans and assessments as required Monitoring & auditing clinical records, ensuring accuracy & timeliness Informing DON of persistent issues related to non-compliant documentation Protecting the confidentiality of Resident & Facility information at all times REQUIREMENTS: MUST HAVE PRIOR MDS 3.0 EXPERIENCE Valid New York RN License Long Term Care Experience Required! Must be highly organized, professional & motivated Should have solid computer skills Excellent communication skills Should be friendly and a team worker About us: Troy Center for Rehabilitation and Nursing is an 80-bed rehabilitation and skilled nursing facility located in the South Troy section of the city, minutes away from the eastern bank of the Hudson River. It's a homey, welcoming, well-maintained facility, providing a warm and nurturing environment. Our staff is committed to ensuring the highest quality of life for all our residents, helping each to get stronger, healthier, and happier. We want all residents to leave Troy Center with dignity and independence. Troy Center is a proud member of the Centers Health Care Consortium. Equal Opportunity Employer -M/F/D/V

Coordinates/oversees a designated group of patients being treated by assigned Physical Therapy Assistants (PTA) and any related clinical supervision of such PTAs and provides appropriate therapy evaluations, treatments and modalities in accordance with established VNS health policies and procedures. Works under general supervision. • Establishes patient plan of care (POC) including treatment interventions, appropriate treatment outcomes and frequency and duration of treatment in collaboration with the physician. Coordinates patient POC and collaborates with other health care team members, patient and family/caregiver for optimal patient benefit. • Assesses, evaluates and identifies patient rehabilitation needs and potential using accepted practice standards. • Assesses/makes determination for direct physical therapy services to be provided by a PTA in accordance with VNSNY protocol. Supervises assigned PTA's, making co-visits and overseeing their schedules, caseloads, clinical skills and patient care delivery to ensure compliance with state, federal and VNS Health policy. • Establishes a discharge plan as part of the patient care continuum. • Provides care in accordance with established POC, including patient and family/caregiver teaching. • Evaluates the need for equipment orders and instructs in use of equipment as is appropriate for patient function and safety. Follows up to ensure resolution of problems/issues and adheres to VNS Health policies/procedures on equipment problems. • Assesses patient status and effectiveness of treatment interventions; modifies goals and Rehab POC as appropriate. • Identifies any changes in clinical and psychological status of patient and reports findings to appropriate members of the health care team to ensure quality care of VNS Health patients. • Refers assigned patients to other VNS Health services, as appropriate. • Initiates and maintains timely communications with the health care team to ensure coordinated quality patient care. Documents all evaluation findings, treatments and patient responses and communications regarding patient care within the timeframe established by VNSNY protocol. • Inputs/enters patient clinical information into appropriate Agency systems (i.e., pen-based, cyber, etc.) to ensure coordinated documentation and patient care. • Acts as coordinator of care when indicated according to VNS Health policy and procedures. • Participates in Rehabilitation Department and Agency meetings, in-service programs, Quality Assurance reviews, and interdisciplinary team meetings as requested. Participates in performance improvement via participation in co-visits and conferences with Rehabilitation Department supervisors. Collaborates as required in assigned service delivery team events. • Contributes to cost-effectiveness of services and programs of the Agency by maintaining knowledge of third-party payer regulations, and adhering to them. • Keeps abreast of the field of physical therapy, assumes responsibility for professional growth and maintains high level of clinical knowledge and skills. Supports the philosophy, mission, and vision of the Agency through attitude and work ethics. • Performs all duties inherent in a supervisory role. Ensures effective staff training, interviews candidates for employment, evaluates staff performance and recommends hiring, promotions, salary actions, and terminations, as appropriate. • Participates in special projects and performs other duties as assigned. Qualifications Licenses and Certifications: License and current registration to practice, as a Physical Therapist in the State of New York Required Education: Bachelor's Degree or Master's Degree in Physical Therapy from a program registered by the Department of Education or accredited by a national accreditation agency Required Work Experience: Minimum of two years experience as a Physical Therapist Required Minimum of one year supervisory experience Preferred Pay Range USD $85,000.00 - USD $106,300.00 /Yr. About Us VNS Health is one of the nation's largest nonprofit home and community-based health care organizations. Innovating in health care for more than 130 years, our commitment to health and well-being is what drives us - we help people live, age and heal where they feel most comfortable, in their own homes, connected to their family and community. On any given day, more than 10,000 VNS Health team members deliver compassionate care, unparalleled expertise and 24/7 solutions and resources to the more than 43,000 “neighbors” who look to us for care. Powered and informed by data analytics that are unmatched in the home and community-health industry, VNS Health offers a full range of health care services, solutions and health plans designed to simplify the health care experience and meet the diverse and complex needs of the communities and people we serve in New York and beyond.

Adams & Martin Group is working with a prominent nationwide legal organization in its search for a Case Manager in its Midtown Manhattan location. This is an opportunity outside of traditional litigation, giving those with law firm experience the opportunity to work specfiic within alternative dispute resolution cases. The Case Manager (CM) provides essential administrative and operational support to panelists handling arbitrations and mediations. This role ensures smooth case management processes and delivers an excellent experience for clients and panelists. The Case Manager focuses on mastering case management fundamentals while maintaining strong client relationships and contributing to the success of the alternative dispute resolution (ADR) process. Key Responsibilities: Case Administration: Maintain accurate case files and records, ensuring all documents are current and organized throughout the case lifecycle. Scheduling & Coordination: Arrange hearings, conference calls, and related activities, balancing client and panelist needs to ensure timely and efficient proceedings. Panelist Support: Provide administrative assistance to assigned panelists, including managing routine tasks and following up on case-related actions promptly. Client Service: Respond quickly and professionally to client inquiries and website requests, delivering a high standard of service and clear communication. Process Management: Monitor case timelines, track deadlines, and ensure all milestones are met to maintain compliance and efficiency. Collaboration: Work closely with management and ADR teams to prepare and distribute panelist lists for arbitration filings or client requests. Issue Resolution: Communicate effectively with clients, panelists, and internal teams to address and resolve questions or issues that arise during case management. Learning & Development: Participate in training and hands-on learning to build proficiency in ADR practices, case management systems, and workflows. Qualifications Bachelor's Degree in Business, Operations, Management, or related field. 2-4 years of experience in case management. 2-4 years of experience in a legal or client service role. Familiarity with ADR processes and procedures, including mediation, arbitration, and court reference matters. Computer literacy and proficiency in various software programs. Strong written and verbal communication skills. Emotional intelligence and adaptability under pressure. Ability to organize, prioritize, and manage multiple tasks in a fast-paced environment. Knowledge of panelists' practice areas and preferences. All qualified applicants will receive consideration for employment without regard to race, color, national origin, age, ancestry, religion, sex, sexual orientation, gender identity, gender expression, marital status, disability, medical condition, genetic information, pregnancy, or military or veteran status. We consider all qualified applicants, including those with criminal histories, in a manner consistent with state and local laws, including the California Fair Chance Act, City of Los Angeles' Fair Chance Initiative for Hiring Ordinance, and Los Angeles County Fair Chance Ordinance. For unincorporated Los Angeles county, to the extent our customers require a background check for certain positions, the Company faces a significant risk to its business operations and business reputation unless a review of criminal history is conducted for those specific job positions.

MDS Manager (RN) Type: Full-Time, Permanent Salary Range: $85,000 - $95,000 annually Sign-On Bonus: $5,000 (with 2-year work commitment) Join Our Compassionate and Skilled Healthcare Team We are seeking a dedicated and experienced MDS Manager to lead our clinical documentation and reimbursement efforts in our long-term care facility. If you're an RN with a strong background in MDS coordination and a passion for improving resident outcomes, we'd love to hear from you! Key Responsibilities Maintain current MDS status for all residents in compliance with state/federal regulations (OBRA, Medicare PPS, Medicaid payment systems). Provide ongoing MDS/RUGs training and education to staff. Conduct focused documentation audits to ensure regulatory, clinical, and financial compliance. Act as a liaison between providers, residents, families, and payers to support optimal reimbursement. Review residents and records to identify those needing enhanced or acute care. Ensure accurate and timely medical documentation and clear interdisciplinary communication. Coordinate care conferences to support proper services and level of care. Participate in government agency and payer audits, surveys, and inspections. Qualifications Current NYS Registered Nurse (RN) license required. RNAC certification preferred. Previous experience in long-term care/geriatric nursing is required. Strong working knowledge of MDS, PPS, Medicare/Medicaid regulations, and long-term care standards. Proficient in care planning, quality assurance, documentation review, and appeals processes. Excellent communication, leadership, and organizational skills. Competency in using EMRs, MDS software, and general office systems. What We Offer $5,000 Sign-On Bonus (2-year commitment) 24 days PTO in your first year 401(k) with company match Full benefits starting the 1st of the month following 30 days of employment Long-term disability and life insurance Supportive and collaborative work environment focused on quality care and continuous learning Ready to make a meaningful impact? Apply today and become a part of a team that values excellence, compassion, and professional growth in long-term care.

Precision, Compassion, Results-Join the Team That Delivers You could be just the right applicant for this job Read all associated information and make sure to apply. Set your sights on a career with NewYork-Presbyterian Queens and play an integral role in our goal to provide the highest level of complex and innovative surgical care, education for the next generation of surgeons as well as groundbreaking quality enhancements and clinical research. Our Surgical Outcomes Coordinators utilize a uniquely collaborative healthcare model, interfacing with the entire surgical team, including nurses and anesthesia staff to assist with oversight and maintenance of the surgical quality platforms within the Department of Surgery. Surgical Outcomes Coordinator | Per Diem Transform your career as a Surgical Outcomes Coordinator and work closely with widely renowned clinical leaders. Utilize your clinical expertise and your keen eye for detail in analyzing, identifying, and recommending opportunities for improvement based upon the noted patterns and trends. Abstract designated surgical cases within the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) and Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) to help make tomorrow better for countless individuals. Move into the next phase of your career with this dynamic opportunity. Participate in the peer review process, resident education and research. Be a part of an all-embracing culture of teamwork , collaboration and innovation . Enjoy flexible scheduling, strong nurse-physician partnership, and opportunities for professional advancement, ours is a destination workplace for talented Quality Improvement Specialists. Preferred Criteria * Prior NSQIP and/or CDI experience Required Criteria * Bachelor's degree * NYS licensed Nurse Practitioner, Registered Nurse, or Physician Assistant * Certification/recertification as SCR through ACS NSQIP. * Certification/recertification as SCR through MBSAQIP * 5 years of recent hospital experience and/or verifiable Documentation Improvement experience #LI-MM1 Join a healthcare system where employee engagement is at an all-time high. Here we foster a culture of respect, belonging, and inclusion. Enjoy comprehensive and competitive benefits that support you and your family in every aspect of life. Start your life-changing journey today. Please note that all roles require on-site presence (variable by role). Therefore, all employees should live within a commutable distance to NYP. NYP will not reimburse for travel expenses . __________________ * 2024 "Great Place To Work Certified" * 2024 "America's Best Large Employers" - Forbes * 2024 "Best Places to Work in IT" - Computerworld * 2023 "Best Employers for Women" - Forbes * 2023 "Workplace Well-being Platinum Winner" - Aetna * 2023 "America's Best-In-State Employers" - Forbes * "Silver HCM Excellence Award for Learning & Development" - Brandon Hall Group NewYork-Presbyterian Hospital is an equal opportunity employer. Salary Range: $81.00/Hourly It all begins with you. Our amazing compensation packages start with competitive base pay and include recognition for your experience, education, and licensure. Then we add our amazing benefits, countless opportunities for personal and professional growth and a dynamic environment that embraces every person. xevrcyc Join our team and discover where amazing works.

Estimated 4 months 5 days on site Must Haves:Bachelor's Degree 2+ years of relevant experience Proficiency in Microsoft Office, Google Workspace, Zoom, and Airtable. Familiarity with digital design tools such as Canva and Social Tables. Strong data management and organizational skills, with experience maintaining registration forms and guest lists. Preferred Skills:Demonstrated experience in event planning, logistics, staffing, or project coordination in a fast-paced environment. Commencement Coordinator The University Ceremonies Office is responsible for organizing and executing some of the university's most significant events. These include Commencement ceremonies, Inauguration, Trustee-related events, and other key ceremonial occasions that celebrate the university's achievements and traditions. We seek a proactive and detail-oriented individual to join our team. This individual will be instrumental in managing logistical, programmatic, and communication aspects related to Commencement week. The role provides support with event planning, ceremony materials and participant outreach, volunteerism, and staff training and management, to contribute to the smooth and efficient execution of various projects. Responsibilities Develop and update program-related materials including seating diagrams and floor plans, academic procession documents, cue cards, scripts, and other assets as needed. Support and manage outreach to key event participants, including speakers, honorees, university leadership, and other guests. Set up registration forms, track responses, and communicate all logistical details. Conduct research and develop materials in support of Trustee-related events. Source potential venues, draft budget estimates and proposals, collect attendee biographies, fulfill supply needs, and prepare event checklists and other communications as needed. Serve as a primary event staff lead, coordinating the hiring, training, scheduling and management of event staff who will support the Ceremonies team onsite, leading up to and during Commencement week events. Oversee the recruitment, training, logistics and day-of management of University volunteers dedicated to supporting Commencement stage participants and VIP guests onsite. Develop training materials and lead all communications to this group. Provide administrative and logistical support before, during, and after assigned events. Perform additional duties as assigned to support the overall success of the University Ceremonies team and the Office of the Secretary. Minimum Qualifications Bachelor's degree and a minimum of two years of related experience. Proficiency in Microsoft Office, Google Workspace, Zoom, and Airtable. Familiarity with digital design tools such as Canva and Social Tables. Strong data management and organizational skills, with experience maintaining registration forms and guest lists. Demonstrated ability to work under pressure while maintaining accuracy and attention to detail. Availability to work early mornings, evenings and weekends as required during peak event periods. Preferred Qualifications Exceptional written and verbal communication skills. Strong organizational skills with high attention to detail and the ability to manage multiple priorities simultaneously. Demonstrated experience in event planning, logistics, staffing, or project coordination in a fast-paced environment. Proven ability to collaborate effectively with colleagues and vendors. Commitment to professionalism, discretion, and high standards of customer service.

Something Extraordinary Every Day™ As our Retail Coordinator, you will support the Retail team with new boutique and restaurant openings, and provide support services to existing brands and restaurants in the Village. You will be responsible for helping the team communicate and roll out retail initiatives, and report results to our internal stakeholders and brand partners. What you will be doing: Managing, organizing, and maintaining all administrative aspects of the Retail team's day-to-day operations including, but not limited to, calendaring and digital filing systems. Ensuring timely and accurate data entry across all internal systems, including sales tracking, stock movement and compliance documents. Supporting the implementation of the Village's retail strategy, in order to deliver the business goals. Assisting with the onboarding of new brands, educating them on our ways of working and providing a warm welcome to the Village. Coordinating internal and external communications in order to foster productive and profitable business relationships. Supporting seasonal campaigns by ensuring effective and well-coordinated efforts between the Retail and Marketing teams. Compiling performance information, including sales data and organizing weekly dashboards. Designing the weekly brand newsletter and compiling timely updates. Tracking the team calendar and ensuring appropriate coverage in the Village for all weekdays, weekends and holidays. Maintaining up-to-date contact lists for Village brand employees. Organizing and participating in the monthly Boutique Manager update meeting. Working alongside the Retail leaders, as needed, as a liaison between brands and Village teams. Participating in ad hoc projects. What makes you special Every colleague is an entrepreneur at heart and this drives our organizational culture, which values invention, innovation and risk taking. To be successful with us, you'll have: Previous experience in an administrative support role, ideally serving multiple departments or function heads. A background in the fashion or luxury retail industry. Excellent interpersonal skills and a customer-centric approach to solutioning. Strong analytical skills and financial sense, with an eye for detail. Excellent project management skills, with the ability to both plan and execute multiple projects simultaneously; strong organizational and prioritization skills. Strong written and verbal communication skills. Computer literate and high proficiency with Microsoft Office (Excel, Word, PowerPoint). Ability to work holidays, evenings, and weekends on a rotational basis and according to the activation calendar. Fluency in English; any other languages would be advantageous. There's no one quite like us The Bicester Collection are the worlds' leading luxury shopping destinations, and we are committed to creating magical and memorable experiences for our guests. Taking the name of the founding Village, The Bicester Collection distinguishes the 11 Villages in Europe and China as one collection of destinations for our guests, our brand partners, our travel and tourism partners, our corporate and financial media, and our internal teams. Our Vision is to be the best shopping destination in the world. Our Mission is to make the lives of others better - our brands, our guests, our people and our communities. Our Brand Promise is to offer something extraordinary every day. Our Five Values are the glue that bind us together and allows us to lead ahead: Authenticity - Always do the right thing Innovation - Think outside of the box Passion - Do what you love and love what you do! Critical Thinking - Challenge the obvious Vision - Be mission driven always Why we're exceptional The key to our success is the quality and commitment of our people. To work in one of the teams at any of the Villages is to play an active role in redefining both the art and the science of retail. This creates a dynamic approach that underpins our ability to anticipate future trends in a fast-changing world. In return for your Authenticity, Critical Thinking, Innovation, Passion and Vision, you'll receive a generous salary and we'll also reward you by: Looking after you: You're entitled to up to 35 days of paid time off, plus holidays. We provide an amazing benefits' package including medical, dental, vision, flexible spending accounts, life insurance, generous short- and long-term disability. We also offer a generous 401(k) match, Employee Assistance Program, and additional ancillary benefits. Treating you: We offer a very generous employee referral bonus. Championing you: You'll be working within a creative and collaborative environment like no other, with the opportunity to develop your professional and personal skills while advancing your career. Come and live your story with us The key to our success is the quality and commitment of our people. The Bicester Collection is made up of 1,200 colleagues of 50 nationalities. We are diverse in background, age, experience and leadership style. We believe that an inclusive workforce makes magic happen, and with this in mind we welcome everyone - regardless of age, gender identity, race, sexual orientation, physical or mental ability or ethnicity - to be a part of our family. We are offering a fantastic opportunity for a professional and commercially focused individual to join us. We have huge ambition for what we can achieve together and we want to have fun! This job posting is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice. Belmont Park Village is an Equal Opportunity Employer and does not discriminate based on the basis of actual or perceived age, race, creed, color, national origin, sexual orientation, gender identity or expression, military status, sex, disability, predisposing genetic characteristics, familial status, marital status, or status as a victim of domestic violence, arrest record or conviction record, or sincerely held practice of religion or any other characteristic protected by federal, state, local, or other law (“Protected Characteristics”).

Job Title: Textile Coordinator (Contract - 2-3 Months) Type: W2 Contract Duration: 2-3 Months Pay Rate: $15-$20 per hour (W2) About the Role We are seeking a Textile Coordinator to support the textile development team in all aspects of fabric and color development. This role is ideal for someone with a background in textiles who enjoys hands-on work with materials, maintaining organization, and supporting technical processes that ensure high-quality finished products. You will work closely with Textile Technologists and product development teams to ensure fabrics, colors, and components meet performance and quality standards before they move into production. Key Responsibilities Assist in all stages of fabric development, including organization of swatches, reviewing fabric submissions, and helping evaluate performance and quality. Support the color development process by tracking lab dips, maintaining color libraries, and organizing color submissions/approvals. Prepare fabric and trim samples for testing; assist with basic textile quality checks such as shrinkage, colorfastness, and hand-feel evaluations. Maintain accurate records and documentation within internal systems, spreadsheets, and tracking tools. Coordinate sample shipments, deliveries, and vendor submissions as needed. Help maintain the fabric library, color standards, and sample room organization. Provide day-to-day administrative and operational support to the Textile Technologists and product development team. Ensure all materials meet quality requirements before approval for production. Required Qualifications Degree in Textile Science or equivalent experience in textile materials, textile R&D, or fabric development. 2-3 years of experience working in textiles, raw materials, fabric testing, product development, or a related technical field. Strong understanding of fibers, yarns, fabric construction, dyes, finishes, and basic textile testing methods. Excellent attention to detail, organizational skills, and time-management abilities. Ability to work hands-on with fabrics, swatches, and color samples in a fast-paced environment. Proficiency in Excel and basic tracking tools; familiarity with PLM systems is a plus. Who Will Succeed in This Role Someone early in their career with strong technical textile knowledge. A candidate who enjoys working with materials and colors in a structured, detail-driven environment. Individuals who can multitask, stay organized, and support multiple development tasks simultaneously. Work Environment This is a fully onsite role in Manhattan, NY. You will work in a collaborative product development environment with daily interaction with the textile/materials team. Benefits that Russell Tobin offers: Russell Tobin offers eligible employee's comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance and hospital indemnity), a 401(k)-retirement savings, life & disability insurance, an employee assistance program, identity theft protection, legal support, auto and home insurance, pet insurance, and employee discounts with some preferred vendors.

This independent, for profit, state-of-the-art, clinical and anatomic pathology reference laboratory is seeking a permanent, full-time Point of Care Coordinator. Under the direction of designated Rapid Response Laboratory management staff and/or hematology and chemistry technical supervisors, the Coordinator will… - Monitor all onsite and off-campus bedside testing - Review patient test results - Track quality control and quality assurance - Oversees Point of Care proficiency testing - Functions as an educator and/or researcher of new test methods and procedures - Performs other technical duties as needed Required education and experience: - Bachelor's Degree in Medical Technology - Qualify as a Medical Technologist under NYS Department of Health Regulation - NYS CLT license required

If you believe healthcare is a right, that everyone deserves high quality care so they can enjoy their highest level of health and wellbeing, and you value each person's individual story - consider joining us at Neighborhood! As a care coordination supervisor you can develop a team, and have an important role in creating a positive experience and improving health outcomes for patients. And, you won't be working weekends. About the Role: As a care coordination supervisor at Neighborhood, you will supervise site level care coordination, overseeing a team of care coordinators. You'll draw on your experience to identify, encourage and develop the skills and talents of your employees so they can better serve patients. Responsibilities include: * Supervise care coordination operations and staff * Coordinate training and procedural oversight * Monitor patient support and issue resolution * Monitor metrics for care gap closure, referrals, labs, and procedures * Allocate resources to handle volume Roles are available at two of our city sites: Northwest - 155 Lawn Avenue, Buffalo Riverway - 1569 Niagara Street, Buffalo What it's Like to Work at Neighborhood: The top three words employees say describe the work environment are: teamwork, supportive, kind. These are from an anonymous survey of Neighborhood employees for the Buffalo Business First Best Places to Work competition. Neighborhood has earned "finalist" distinction in the competition the last four years. We are a group of flexible and kind individuals who are open to each other's ideas, and see opportunities to innovate and find solutions when challenges arise. Education and Skills: * High school diploma or equivalent * 1+ years' experience in community health, care coordination and/or outreach preferred * Maintain CPR and licensure(s)/certifications required to perform job duties * Excellent oral and written communication skills * Read, write, and speak the English language. A second language of Spanish is preferred * Kindness: you treat each person with respect and compassion, valuing each person's story * Resiliency: you see opportunities to innovate and find solutions when challenges arise * Teamwork: you are open to others' unique perspectives, and will collaborate to meet shared goals What We Offer: Compensation: $29.50/hour - $33.00/hour Individual compensation is based on various factors unique to each candidate, including skill set, experience, qualifications, and other position related components. Benefits: You'll have options for medical, dental, life, and supplemental insurance. We also offer a 403b match, health savings accounts with employer contribution, wellbeing programs, continuing education opportunities, generous paid time off, holidays. About Neighborhood: Neighborhood Health Center is the largest and longest serving Federally Qualified Health Center in Western New York, and is the highest ranked health center for quality in the region. We provide primary and integrated healthcare services all under one roof, regardless of a person's ability to pay. Services include internal/family medicine, pediatrics, OB-GYN, dentistry, podiatry, psychiatry, vision care, nutrition and behavioral health counseling, and pharmacy services. We're working toward a Western New York where all enjoy their highest level of health and wellbeing. Neighborhood Health Center is an equal opportunity employer.

Job Title: Family Health Network Care Coordinator Reports to: FLIPA Community Health Worker Supervisor and Family Health Network Chief Strategy Officer will be In-Person located in Cortland NY ******* Social Care Network Summary: TheNew York State Department of Healthhas established Social Care Networks (SCNs)as part of the1115 Waiver Demonstration Amendment, The SCNs aim is to enhance the delivery of social care services to Medicaid membersby coordinating efforts amongcommunity-based organizations (CBOs) and other health care partners to create a more resilient, flexible, and accessible social care system that reduces health disparities and advances health equity. The SCN will collaborate with CBOs and other health care partners, leveraging shared data and technology to coordinate social care services for Medicaid members to improve access, ensure reliable and timely referrals, streamline and track navigation and completed referrals in closed loop systems and enhance collaboration between social care service providers and other regional partners. Job Summary: This position is responsible for establishing trusting relationships with patients while providing support in navigating and accessing resources and engaging patients in goal-driven care. The Care Coordinator systematically identifies, assesses, refers, and monitors high-need individuals to ensure access to essential services while supporting providers and the Care Team through an integrated approach to care management and community outreach. This position is funded through March 2027. Organizational Overview: Forward Leading IPA (FLIPA) is a nonprofit membership association of safety net providers working in partnership to provide the highest quality integrated healthcare to historically underserved populations in Upstate New York since 2017. FLIPA is renowned for its commitment to integrating primary care, behavioral health, and social care needs. Our growing membership serves individuals across Upstate NY and includes federally qualified health centers (FQHCs), behavioral health providers, and a rural health network consisting of eight county public health departments. Equal Employment Opportunity Statement: At Forward Leading IPA (FLIPA), we deeply value diversity in background, experience, and thought. We are committed to creating an environment of belonging where all qualified applicants are encouraged to apply and will receive equal consideration for employment. We do not discriminate based on race, color, religion, age, sex, gender identity or expression, national origin, disability status, veteran status, or any other characteristic protected by federal, state, or local laws. We believe that fostering spaces of belonging and advancing health equity begins with a workforce that reflects the diverse communities we serve. We actively promote equity of opportunity and strive to ensure that each team members unique skills, talents, and potential are recognized and valued. We are dedicated to supporting and welcoming a wide range of candidates, making hiring decisions based solely on individual merit. FLIPA is committed to prioritizing the human element in healthcare. By embracing diverse perspectives and fostering innovative thinking, we aim to build empowered, healthy, and thriving communities. Join us on this journey and contribute to a mission that makes a meaningful impact. Security Level: Shared Staff - FLIPA Duties/Responsibilities: Provide a vital link between local communities and healthcare provider by helping individuals access resources and navigate systems. Proactively outreach and engage identified individuals in need of services, follow up or social care screening by connecting via phone calls, home visits and/or in-person visits to other settings where patients can be found. Support deployment of NYS Social Care Network screening and referral process Engage directly with Medicaid individuals to administer the Health-Related Social Needs Screening Tool to identify needed areas of support. Facilitate referrals to appropriate community resources and healthcare providers. Collaborate with the Care Team to ensure timely follow-up and service linkage. Use designated online referral systems and databases to track and manage client referrals. Provide care management related to social care services Accurately document in electronic systems and maintain detailed and organized records in compliance with organizational policies and standards. Work closely with the Care Team, including care coordinators and other healthcare professionals, to align to a whole person care approach. Participate in regular team meetings and contribute insights on client progress. Attend regular supervision, staff meetings, trainings and other meetings, as requested. Other duties as assigned Education & Experience: Minimum of High School Diploma or GED. Associate's degree in human services, Social Work or other related degree preferred. Equivalent experience in lieu of education may be considered. Minimum of 1-3 years' human services experience. Skills, Knowledge, and Abilities: Possess excellent verbal and written communication skills. Exceptional customer service skills with commitment to helping others. Ability to quickly adapt and be flexible in approach to job tasks and challenges and maintain emotional control under stress. Excellent time management skills with exceptional attention to detail and the ability to multi-task and manage multiple priorities with competing deadlines. Capability to work cooperatively with culturally diverse clients, staff, and community service providers. Basic computer literacy, including the ability to use email, conduct online research, and create basic documents (MS Office Suite including Excel, Outlook and Word). NYS motor vehicle license, safe driving record and availability of personal vehicle for work. Holds self and others responsible and accountable to meet commitments. Salary Range: Salary is commensurate to education and experience with a range of $18.27 to $28.85 per hour Additional information: This position is an in-person role, embedded within Family Health Network, a FLIPA member organization. This position will be located in Cortland NY.

Care Coordinator (LPN) Schedule: Full-Time Salary: $64,000 - $70,000 per year About Infinite Medical P.C. Infinite Medical P.C. is a nationwide network of advanced practice providers and specialty clinicians committed to delivering high-quality, proactive care directly to residents in skilled nursing and long-term care facilities. Our partnership with MedElite Healthcare Management Group empowers us to focus on what matters most: providing compassionate, personalized care that meets the unique needs of each resident. Together, we champion continuous innovation and collaboration in our shared mission to redefine senior care across the country. Job Summary We are seeking a dedicated Care Coordinator (LPN) to join our team. In this role, you will be responsible for reviewing patient charts and communicating with the Clinical department and providers about any irregularities as part of chronic care management. Responsibilities Provide assessment and care management services, including: Administration of validated rating scales. Initiation of behavioral health care planning concerning behavioral or psychiatric health problems. Revision and modification of care plans for patients not progressing or whose status changes. Brief psychosocial interventions as needed. Engage in ongoing collaboration with the billing practitioner. Maintain the registry/tracking sheets. Consult with the psychiatric consultant. Maintain a continuous relationship with patients. Foster collaborative, integrated relationships with the rest of the care team. Conduct interdisciplinary care plan meetings to review patient beneficiaries. Requirements LPN degree/ certificate required. Experience in long-term care preferred. Experience in behavioral health preferred. Benefits Health Dental Vision 401K Company-Sponsored Life Insurance Paid Time Off $1,000 Sign-on Bonus Why Work With Us? Make a meaningful impact on the lives of seniors Work in a collaborative, mission-driven environment Enjoy work-life balance Equal Opportunity Employer Infinite Medical P.C is an equal-opportunity employer. We acknowledge and honor the fundamental value and dignity of all individuals. We pledge ourselves to crafting and maintaining an environment that respects diverse traditions, heritages, and experiences. Infinite Medical P.C is an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based on race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. The above-noted job description is not intended to describe, in detail, the multitude of tasks that may be assigned but rather to give the applicant a general sense of the responsibilities and expectations of this position. As the nature of business demands change so, too, may the essential functions of the position. Ready to Make a Difference? Apply today and help us deliver compassionate, personalized care where it matters most.

At Essen Health Care, we care for that! As the largest privately held multispecialty medical group in the Bronx, we provide high-quality, compassionate, and accessible medical care to some of the most vulnerable and under-served residents of New York State. Guided by a Population Health model of care, Essen has five integrated clinical divisions offering urgent care, primary care, and specialty services, as well as nursing home staffing and care management. Founded in 1999, our over 20-year commitment has fueled an unwavering dedication toward innovating a better healthcare delivery system. Essen has expanded from a single primary care office to an umbrella organization offering specialties from women's health to endocrinology, from psychiatry to a vast array of other specialties. All clinical services are offered via telehealth or in-person at over 35 medical offices and at home through the Essen House Calls program. Essen House Calls provides in-home primary and specialty care in the New York Metro area. We are looking for the most talented and effective individuals to join our rapidly growing company. From medical providers to administration & operational staff, there is a career here for you. Join our team today! Job Summary Position Title: HARP Clinical Care Coordinator Job Summary: The HARP Clinical Care Coordinator plays a dual role within the healthcare practice, seamlessly blending clinical support with care coordination. This position ensures patients receive compassionate, holistic, and well-organized medical care by assisting providers during clinical procedures while also coordinating health and social services that support overall well-being. Under the supervision of the HARP Care Coordination Supervisor, the Health and Recovery Plan (HARP) Care Coordinator will manage care for adults with significant behavioral health needs. They will facilitate the integration of physical health, mental health, and substance use services for individuals requiring specialized approaches, expertise, and protocols which are not consistently found within most medical plans. In addition to the State Plan Medicaid services offered by Mainstream Managed Care Organizations (MCOs), qualified HARPs will offer access to an enhanced benefit package comprised of Home and Community-Based Services (HCBS) designed to provide the individual with a specialized scope of support services not currently covered under the State Plan. Responsibilities Gather information for intake, assessment, and reassessments. Provide care management and support to a caseload through the coordination of medical, mental health, HCBS and substance use services. Conduct assessments and prepare a comprehensive plan of care as directed by NY State and Managed Care Organizations. Collaborate with the individual's HARP team including: MCOs, HCBS providers, as well as other medical and treatment providers. Generating referrals to providers, community-based resources, and appropriate services and other resources to assist in goal achievement. Ensure entitlements, insurance, and benefits are in place and maintained. Develop service plans and resolve barriers to effective service utilization. Monitor member's progress in utilizing services (appointments, treatment, medication, etc.) through telephonic and direct contact. Attend and prepare for Interdisciplinary Care Team meetings which will feature newly enrolled, frequently admitted, high utilizing at risk members. Accompany members to/from any appointments when needed. Documents in a comprehensive manner to ensure that all goals, interventions, and care coordination activities for each member in EMR system, and other applicable software programs, are compliant with professional standards and regulatory guidelines. Educate members on health-related conditions and support members in addressing gaps in health care through connection to direct care providers, resources and medications, as appropriate to members conditions. Assist in crisis intervention and provide or refer to crisis services. Extensive fieldwork required, including home visits and community work such as visiting hospitals and emergency rooms when determined necessary. Ensure that members follow-up with aftercare discharge (i.e. fill prescriptions, make appointments). Assists with maintaining quality, preparing for audit revies, and quality improvement projects. Attend regularly supervision, staff meetings and relevant training as required. Qualifications Bachelor's Degree Required in one of the following fields: Social Work, Psychology, Education, Rehabilitation, Occupational Therapy, Counseling, Community Mental Health, Sociology, Physical or Recreational therapy. Degrees in other related areas may be considered. For bachelor's level candidates, two (2) years OR for master's level candidates, one (1) year of related experience working with individuals with severe mental illness. Ability and willingness to regularly travel with members, in some instances to many locations using various modes of reliable and safe transportation. You must have excellent interpersonal and time management skills. Proficiency in email and documentation on electronic platforms. Comfortable with fieldwork and navigating social services systems. Working knowledge of NY State Health Home System and Plan of Care process. Case Management Experience within the Integrated Collaborative Care Model Approach. Previous history of conducting discharge planning and providing direct education around medical conditions. Knowledge of Psyckes, E-Paces, HCS (UAS) MAPP, Microsoft Teams Video knowledge preferred. Strong interpersonal and assessment skills, the ability to remain calm and poised with challenging members who often present as in a constant state of crisis. Experience with chronic condition management, particularly Diabetes, HIV, Heart Disease. Ability to multi-task and work under multiple priorities and deadlines in a fast-paced environment. Computer literacy: Proficiency with Word and Excel. Equal Opportunity Employer Essen Health care is proud to be an equal opportunity employer, and we seek candidates who desire to work in and serve an ethnically diverse population.

Named City and State's Top Place to Work in NY (2025) - Join a mission-driven mental health leader serving 15,000+ clients each month! Celebrating over 50 years of excellence, New York Psychotherapy and Counseling Center (NYPCC) is a leader in community mental health, serving over 15,000 clients each month across four locations. We operate the largest mental health clinic in New York State and are committed to innovation and Caring for the Community through both in-person and telehealth services. NYPCC is proud to be certified as a Platinum Bell Seal organization by Mental Health America - the highest distinction for workplace mental health. We were also named one of the Top Places to Work in New York in 2025, reflecting our commitment to supporting, valuing, and investing in our dedicated team through competitive compensation, excellent benefits, and a mission-driven culture. Why Work at NYPCC: We Pay Down Student Loans Medical, Dental, and Vision Insurance is Paid for by NYPCC 100% Paid Time Off and Company Paid Holidays Annual Rate Increases 403B Retirement Plan with Company Match! Continuing Education Opportunities Available Professional Development through NYPCC Academy Amazing Workplace Culture Are You a Good Fit? We are currently seeking an energetic, bright, and self-motivated Care Coordinator to join our team. This is a full-time position that will be based out of our state-of-the-art Child and Family Health Center located at 2857 Linden Blvd, Brooklyn, NY 11208. Gateway to Wellness is a Health Home Care Management initiative being implemented by New York Psychotherapy & Counseling Center (NYPCC) to supplement and enhance the current behavioral health services we offer and provide throughout the NYC area. Job Description Manage a 85+ caseload of Health Home Care clients Assist in developing a Comprehensive Care Plan Address various service needs (e.g. Housing, Benefits, medical care, transportation, education, employment, Crisis Intervention and other supportive services to enhance client's quality of life) Work as a member of Care Team including; Supervisor, Clinicians, verbal Psychotherapists, and Psychiatrists Successfully execute advocacy, assessment, service planning, creating linkages/referrals and ongoing documentation and monitoring of Electronic Health Records Contact individuals diagnosed with mental illness, substance abuse disorders and chronic medical conditions that significantly impact functioning on a monthly basis in person and by phone Qualifications MUST be Bilingual (English/Spanish) Experience with RMA required Experience with HARP clients preferred Possess knowledge of various resources and services within a community to assist with overall service delivery and linking members to the services they need or want based on a client-centered service plan Possess excellent verbal and written communication skills to be able to provide linguistically appropriate services to their assigned caseload Communicate with other professionals, a network of providers and managed care organizations regarding client statuses, level of functioning and needs for additional services NYPCC is a fast-paced, energetic, dynamic environment that employs people with a passion for our mission. We offer a very competitive salary with full benefits including; Medical, Dental, Vision, Paid Time Off, Salary Increases, Bonuses, 403b Retirement Plan and more. Perkins and other loan forgiveness may also be available, in addition to our Student Loan Pay Down incentive. NYPCC is an Equal Opportunity Employer Additional Information Salary: $45,000 - $50,000 per year All your information will be kept confidential according to EEO guidelines.

Cornerstone Family Healthcare is actively recruiting for a HVC Care Coordinator to join our growing team in Monticello. RATE OF PAY/SALARY: $27.47 per hour STATUS: Full-Time CORNERSTONE BENEFITS: Competitive salaries I Health Benefits I Retirement plan I Paid Time Off I Sick Time I Flexible Spending I Dependent Care I Paid Holidays CORNERSTONE'S MISSION: Cornerstone Family Healthcare is a non-profit Federally Qualified Health Center with a mission to provide high quality, comprehensive, primary and preventative health care services in an environment of caring, dignity and respect to all people regardless of their ability to pay. For more than fifty years, Cornerstone has been responsive to meeting the needs of the communities in which we serve with a continued emphasis on the underserved and those without access to health care regardless of race, economic status, age, sex, sexual orientation or disability. Under the supervision of the Program Supervisor, the HCV Care Coordinator is responsible for supporting Hepatitis C (HCV) screening, testing and linkage to care. The HCC will be providing HCV screening, immediate phlebotomy for individuals with reactive antibody tests, and patient navigation to facilitate linkage and retention in care for individuals with chronic HCV. Key Competencies: * Conduct outreach to individuals at high risk at the community level as well as within syringe support program, drug rehabilitation centers, shelters, soup kitchens, and other community-based organizations to publicize program services as well as recruit potential clients. * Provide HCV counseling, testing (rapid fingerstick, venipuncture as appropriate), referrals, and partner services to clients at high risk. * Comply with chart requirements and testing protocol such as making sure charts are complete and filled out properly in accordance with departmental/agency policy and procedures. * Complete data entry into the AIRS system, data should be entered correctly for each intervention and service. Data must be entered in a timely manner. Description of Duties: * Maintain program and agency standards as outlined in policies and procedures. * Help clients schedule transportation for medical appointments and troubleshoot barriers to successful linkage to and retention in care. * Track efforts to move patients through the HCV cascade of care through communication and coordination with medical providers, regular chart review and ongoing client contact. * Provide clients with basic HCV treatment education including understanding labs, disease progression, and treatment. * Provide ongoing counseling to address prevention and harm reduction strategies. * Assess biopsychosocial needs, identify barriers to successful linkage, and connect clients to support services as appropriate. * Engage in adherence and retention in care efforts for clients living with HCV which include conducting extensive community outreach efforts to locate lost to care clients; developing client specific strategies to address challenges to care and treatment; maintaining detailed records of all adherence and retention activities. * Maintain ongoing relationships with administrators and staff at community-based agencies to promote program services. * Conduct screening, intake, enrollment and follow-up of clients in the program and enter client data into the agency's AIDS Institute Reporting System (AIRS) in a timely manner consistent with agency policies. * Responsible for quality assurance activities, including maintaining client charts within program standards and ensuring compliance with goals and objectives in the annual workplan. * Complete the mandated continuing education trainings as selected and scheduled by the Program Supervisor and mandated by the agency. * Participate in individual and team supervisions. * Assist in program coverage as needed. * Attend and participate in monthly department, All Staff and other required meetings. * Be familiar with Cornerstone policies and procedures and the Employee Handbook. * Maintain confidentiality of all aspects of Cornerstone including, but not limited to, patient confidentiality, financials, and employee relations. * Perform other related duties as assigned. Requirements * Bachelor's degree in Public Health, Education, Human Services, or similar field with experience in outreach, counseling and prevention. * Or an Associates Degree with two years of experience in testing, counseling and education. * Or High School Diploma with four years of experience in testing, counseling and education will be considered. * Minimum of one year experience working with PWUD population, knowledge of HIV/HCV/STI, harm reduction, mental health and/or community resources.

Job DescriptionPreferred is hiring an onsite Care Coordinator! We offer weekly pay between $22.00-$25.00 an hour! Office hours Monday-Friday 9:00a.m.-5:00p.m. The office location is: 148 39th St. Industry City, NY 11232.Preferred Home Care of New York, a Help at Home Company, is part of the nation's leading provider of in-home personal care services. Our mission is to help individuals live independently and with dignity in the comfort of their own homes. Across the Help at Home family, we support 66,000 clients each month with the dedication of 50,000 compassionate caregivers in 12 states. As a Care Coordinator, you are responsible for the maintenance of ongoing communication with referral and intake sources for all patients. The Care Coordinator shall plan for home healthcare service coverage. The Care Coordinator is responsible for management of current schedule for home care workers, while striving to ensure that patient/family are satisfied and receiving excellent customer service. What You'll Do Understand the administration and management of office operations for home care agencies. Ability to define problems and tasks, collect data and establish facts, take action and facilitate resolve. Ability to perform various computer functions for information concerning patient and aide scheduling and coordination, assisting with communication between departments and overall office operations. Proficient in Customer service and satisfaction What You'll BringWe're looking for someone who is highly organized, service-oriented, and ready to thrive in a fast-paced, mission-driven environment. Required Skills & Experience: Maintains a daily patient roster of assigned services and staffs open cases as needed. Monitors HHA electronic verification via the HHA Exchange “Call Dashboard” throughout the day and is responsible for its maintenance and documentation. Maintains effective communication with contracts via HHA Exchange by revising contract messages, replying promptly, and clearing out respective notes in a timely manner. Communicates with vendor/contract any changes that occur, either with patient/family or HHA. In the event the HHA is changed or replaced, the Care Coordinator is responsible to notify the Human Resource department to send the appropriate documentation to the vendor. Responsible for documenting all incidents (both in HHA Exchange and on Incident Report form) and relaying information to supervisor for follow up and completion of incident reports. Responsible for scheduling replacement HHA's upon request from Human Resource department to ensure HHA compliancy with agency and state regulations. Assists with obtaining contract authorizations where pre-billing conflicts arise. Demonstrates a commitment to maintain a high degree of patient satisfaction and strives to work as a team player with the other coordinators. High school graduate; some college credit preferred. One-year experience in other work-related experience, preferably within the health care services industry. Proficient in Microsoft Office Suite, Constituent Database (HHA Exchange) and Internet Investigative ability, highly organized, self-motivated, takes initiative, excellent written and verbal communication and analytical critical thinking skills; able to perform without much supervision. Understands the regulations governing the home care field, related to Medicare, Medicaid and other insurance. Understanding of communicating effectively with employee, patients and their families, medical and community affiliates in order to develop positive relationships. Benefits: Weekly pay with salary ranges from $22- $25 hourly. Direct deposit Healthcare, dental, and vision insurance Paid time off and parental leave 401k Ongoing, in-depth training opportunities Meaningful work with clients who need your help Career growth and experience with an industry leader with 40+years of history in a high-demand field Why Join Us? - Be part of a growing company with a strong mission and a heart for the community - Work alongside a collaborative, passionate team that values your contribution - Help make a direct impact on the lives of clients and their families every day If you're ready to join a team that's redefining care in New York, apply today! #LI-LT1 The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions upon request. Help At Home is an Equal Employment Opportunity (EEO) employer and welcomes all qualified applicants. Applicants will receive fair and impartial consideration without regard to race, sex, color, religion, national origin, age, disability, veteran status, genetic data, or religion or other legally protected status. Data Security and Privacy Statement At Help at Home, we prioritize protecting your personal information during the hiring process. We comply with all relevant data privacy regulations, including HIPAA and SOX where applicable. Your data will only be used to assess your employment suitability and won't be shared with unauthorized parties. We use strong security measures to protect your information from unauthorized access or disclosure. By submitting your application, you consent to this process. You can access, modify, or request deletion of your data by contacting us. Employees must adhere to our data protection policies and legal requirements to safeguard sensitive information. Powered by JazzHR yFkC0XO8Oy

Job Description Coordination of all cases includes the following: · Attendance · Prebilling · Entering timesheets and requesting initial while doing attendance. · Informing the clinical department of all complaints and incidents documenting in the HHAexchange system as necessary · Receptionist duties Responsibilities: Staff and coordinate coverage for all open-home care cases as needed. Conduct attendance calls to caregivers and patients during scheduled hours. Link all calls during that time Handle high call volumes efficiently and with professionalism. Communicate with office staff and caregivers to ensure proper coverage and timely follow-ups. Provide excellent customer service and maintain accurate documentation. Communicates patient schedules to field staff and job duties for assigned shift(s). Documents all actions accurately and appropriately in the scheduling system. Works with office leadership on any outstanding patients' needs. Escalation as needed. Documents all information and worked time on the on-call log. Performs other duties as assigned Knowledge, Skills, and Abilities: Excellent written, verbal, and interpersonal communication skills. Strong computer/data entry and software skills. Experience working with scheduling-related software. Basic understanding of medical terminology. Ability to work independently

Essen Health Care is a growing community healthcare network that provides high quality, compassionate, and accessible medical care to some of the most vulnerable and under-served residents of New York State. Guided by a ‘population health' model of care, Essen has five integrated clinical divisions offering services in primary & specialty offices, urgent care centers, and nursing homes, as well as house calls for home bound patients; all clinical services are also offered via telehealth. Our Care Management division supports patient-centered care through care coordination, complex care management and helping address health-related social needs. Founded in 1999, Essen provides care in all five boroughs of New York City, with a primary focus in the Bronx. Staffed by over 300 primary and specialty care physicians and advanced clinicians, Essen Health Care is one of the largest, most comprehensive private medical groups in New York City. Essen maintains a Clinical Information Services team that maintains our enterprise-wide electronic medical record system, data repository, clinical analytics and population health capabilities. Our Community Services teams create and sustain relationships with community organizations and agencies and health plans. Essen health is committed to delivering quality care coordination for all patients. Through that end, Essen Health, recently received designation as ‘Level 3 Patient Centered Medical Home' by the National Committee for Quality Assurance. Furthermore, Essen has won several awards for its patient care innovations and recently launched Intention Health Ventures to develop and commercialize its technology innovations. Job Summary Reports to: Care Coordinator Supervisor for HH+ AOT (Hybrid) The AOT care coordinator liaises between the court system, medical system and the community and is responsible for case retention activities, while maintaining a caseload of 15-20 AOT members. The incumbent partners with the members to become involved in all aspects of their care. The care coordinator delivers quality services to ensure compliance and adherence. The care coordinator meets with the members on a weekly basis at their residence, medical appointments and or in the community to address specific care plan goals, which include but not limited to addressing medical and psychiatric , behavioral health needs associated to the designatedcourt ordered treatment plan. Responsibilities In partnership with care team and staff from the Office of Assisted Outpatient Treatment, the AOT Care Coordinator: Maintains a caseload of 15-20 AOT members and performs weekly in-person visits with assigned members. As mandates, in-person visits must be performed at the members' residences or in the community at a convenient location. Performs essential transitional care coordination services, including pre-release contacts, day-of-release warm handoffs, assessments and service planning, and assists with entitlements, housing, vocational rehabilitation, life skills, and reintegration services. Connects members to community support services and outpatient health services, including mental health, substance use, behavioral health, harm reduction and medical services. Leads and advocates for the member during crisis response, case conference and IDT meetings, when applicable. Documents all encounters and interventions timely and completes initial assessments, reassessments, service care plans, progress notes (using DAP format), and discharge plans. Completes all mandated reports in the Health Home Reporting System (FCM) and the Assisted Outpatient Treatment (AOT) portal. Attends compulsory training, related to prison re-entry, harm reduction, overdose prevention and behavioral health/criminal justice. Maintains ongoing communication and partnership with DOCCS/Parole, the Department of Homeless Services (DHS), and the Office of Mental Health (OMH). Provides care coordination services from strength-based, recovery-oriented, trauma-informed, and culturally appropriate approaches. Performs other duties as requested by immediate supervisor. Salary: $48,000-$50,000 Qualifications Bachelor's degree in social services, Human services and Social Sciences or, master's degree in social work with license to practice in New York State. At least six years in the provision of community-based social and case management services. At least two years of experience in a professional environment providing care coordination or clinically based interventions to individuals involved in the criminal justice systems. At least two years in providing direct services to people who are seriously mentally ill, intellectually disabled or chemically dependent. Knowledge of community resources for individuals with serious mental illness, developmental disabilities, or alcoholism or substance abuse. Professional experience in navigating services for homeless and substance use populations with medically and psychiatrically complex needs. Equal Opportunity Employer Essen Health care is proud to be an equal opportunity employer, and we seek candidates who desire to work in and serve an ethnically diverse population.

Health Home Plus (HH+) Care Manager Be the Bridge. Empower Lives. Thrive with Support. Are you driven to help individuals with complex health needs navigate life's most critical transitions? Do you excel when you're out in the community - meeting clients where they are and guiding them toward stability? We're seeking passionate HH+ Care Managers who specialize in transitions of care, with a readiness to be in the field and make real, face-to-face impact. Your Mission: Guide Clients Through Critical Transitions As a Health Home Plus Care Manager, you'll work with individuals living with serious mental illness and chronic conditions, helping them move safely from hospital to home, inpatient care to community support, or detox to ongoing treatment. Extensive fieldwork is at the heart of this role - you'll be on the ground, advocating, coordinating, and walking alongside your clients at every step. What You'll Do ✔️ Coordinate safe, smooth transitions from hospitals, detox/rehab centers, and psychiatric inpatient facilities ✔️ Conduct frequent field visits to client homes, shelters, hospitals, and community agencies ✔️ Develop and manage comprehensive, individualized care plans addressing medical, behavioral, and social needs ✔️ Collaborate closely with providers, discharge planners, and community partners to ensure continuity of care ✔️ Connect clients with housing, benefits, outpatient treatment, peer supports, and other vital services ✔️ Monitor risk factors, ensure follow-ups, and advocate fiercely for each client's stability and wellness ✔️ Support clients in navigating complex healthcare and social systems with compassion and clarity What You'll Bring ✅ Bachelor's degree in Social Work, Nursing, Psychology, or a related human services field (Master's/licensure is a plus!) ✅ At least two (2) years working with individuals with serious mental illness, co-occurring disorders, or chronic conditions ✅ Strong background in care transitions, discharge planning, community outreach, or case management ✅ A self-starter who is comfortable with extensive fieldwork and building community relationships ✅ Excellent communication, organization, and problem-solving skills ✅ Commitment to trauma-informed, person-centered care Why You'll Love This Role ✨ Supportive supervision: Experienced leaders who offer mentorship, guidance, and real-time support ✨ Hands-on, impactful work: See the difference you make every day in the field ✨ Collaborative, mission-driven team that values your voice and expertise ✨ Opportunities for professional growth: Ongoing training, and career advancement ✨ Competitive salary + comprehensive benefits