HHUNY Care Manager

Please be aware that all staff are required to be vaccinated for COVID-19. Proof of vaccination will be required prior to employment.

Finger Lakes Community Health uses BambooHR for the hiring and onboarding of our staff. All communications for recruitment will come directly from BambooHR (notifications@app.bamboohr.com) and may appear as spam. 

About Finger Lakes Community Health:

Finger Lakes Community Health (FLCH) was founded in 1989 with an original mission of serving the region's agricultural workers by linking individuals to area resources and providing essential health services. In 2009 the organization expanded to become a Federally Qualified Health Center (FQHC), serving patients of all incomes, ethnicities and walks of life. Over the last decade, FLCH has grown to provide medical, dental, and behavioral health services to over 28,000 patients at eight health centers. With over 200 employees we strive to provide high-quality and innovative health care services to the Finger Lakes Region.

Benefits Offered:

• Monday through Friday schedule, closed all major holidays
• Medical insurance with a 90%+ employer contribution
• Dental, Vision, and Life insurance
• Safe Harbor 3% 401k contribution
• Robust PTO offerings 
• Education reimbursement

Job Summary:

The HHUNY Care Manager serves as an advocate for the social, physical, and mental well-being of individuals with co-occurring chronic conditions. The position works with the patient to identify goals and is the center point of communication to ensure all providers are working together with the patient in mind.

Main Responsibilities:

Referral & Enrollment Process

• Discuss Health Homes of Upstate New York (HHUNY) program and services with eligible patients via phone and in-person appointments
• Complete enrollment paperwork with patient and upload into the electronic health record and HHUNY system
• Review the HHUNY comprehensive care assessment with patient to ensure accuracy and completion in all areas
• Submit HHUNY comprehensive care assessment before post-enrollment deadline
• Guide patient through developing a client care plan based off of identified problem areas in the HHUNY comprehensive care assessment
  • Client care plan includes goals that are: Smart, Measureable, Attainable, Relevant, and Timely

Care Coordination

• Inform patient care team which includes Finger Lakes Community Health providers, care manager, and outside agencies of client care plan
• Examine care reports for gaps in patient care and work with provider towards related client care plan goal(s)
• Initiate contact with care team to ensure all members are up to date and in alignment with patient updates, concerns, and client care plan goal status
• Follow-up with care team or attend patient appointments to stay informed on patient care
• Update patient risk-level on monthly basis using information from care team and patient interactions

Patient Support

• Advocate for patient needs in patient appointments and care team meetings
• Review emergency room visit and discharge information to ensure a timely follow-up appointment, medication reconciliation, and transition of care
• Collaborate with patient on an effective strategy to communicate and manage care based on patient preference
• Mentor patient on life skills and healthcare system basics such as calling to schedule an appointment as it relates to their client care plan
• Review care information with patient after appointments as part of follow-up care to ensure understanding
• Schedule or provide patient transportation for specialty appointments based on insurance eligibility

Documentation

• Report billing questionnaire monthly to the Health Homes of Upstate New York system
• Reassess client care plan annually or when a triggering life event occurs
• Record case details in the electronic health record and Health Homes of Upstate New York systems including demographics, service provided, and referrals made
• Address telephone encounters, actions, and referrals in the electronic health record system in accordance with Finger Lakes Community Health policies and procedures

Education and Qualifications: 

• High School or Equivalency Diploma
• Minimum of 2 years of experience in a similar role
• Possesses New York State driver’s license
• Current New York State automobile insurance in compliance with FLCH underwriting agreement
  
• The ability to communicate fluently in both Spanish and English is preferred

Physical Requirements: 

• Must be able to hear and communicate with clients and staff via phone, web media, and in person.
• Must be able to lift up to 30 lbs
• Must be able to sit for extended periods of time
• OSHA Level II

Finger Lakes Community Health uses BambooHR for the hiring and onboarding of our staff. All communications for recruitment will come directly from BambooHR (notifications@app.bamboohr.com) and may appear as spam.