Health Navigator​/Care Coordinator, Care Management Services; CMS

Health Navigator / Care Coordinator – Care Management Services

Position: Health Navigator/Care Coordinator, Care Management Services (CMS)

Function: Responsible for the assessment and engagement of clients around health and wellness and the development of a comprehensive care plan.

Reports to: Director, Care Management Services

Location: Manhattan office with travel throughout Manhattan & lower Bronx

Schedule: Mondays-Fridays (9:00am-5:00pm)

• Develop rapport with clients in order to engage them in improving their health and wellness.
• Administer standardized health and psychosocial risk screenings according to Health Home protocols and time frames.
• Utilize health screenings to identify interventions and develop a comprehensive care plan.
• Collaborate with members of the care team to identify needs and develop a plan to help clients achieve optimal health outcomes.
• Implement tasks outlined on the care plan and ensure follow‑up and continuity of care between client interactions.
• Regularly review and update the care plan to correspond with services being provided.
• Document all interventions and attempted contacts in the EHR in accordance with program standards.
• Work in collaboration with care providers to address gaps in care.
• Assess domiciled client’s living conditions by conducting home visits.
• Work with family members and other collaterals of the client’s choice to facilitate planning and delivery of care.
• Provide comprehensive transitional care following hospitalization events in accordance with ACMH Critical Time Intervention (CTI) Protocols.
• Review new information and complex cases with PCP and multidisciplinary team and incorporate recommendations into the care plan.
• Facilitate care delivery by scheduling appointments, obtaining necessary information, and arranging transportation.
• Utilize evidence‑based practices, such as motivational interviewing, to empower clients to grow and attain goals.
• Embrace the team model by collaborating with members of the team and providing support as needed.
• Identify community resources and make referrals as needed.
• Support client goals and serve as an advocate on client’s behalf.
• Administer CSD funds (Client Service Dollars) and submit required documentation.
• Regularly participate in team meetings and weekly clinical conference.
• Attend in‑service training as requested.
• Perform duties as assigned by supervisor.

Education: B.A. or M.A. degree in social services or related field.

Experience: Two years of experience providing direct service in the human service field or nursing or CM/Service Coordination.

Skills: Strong written and verbal communication skills. Bilingual English/Spanish preferred.

Salary: $58,095 plus generous benefits.

Please include a resume, cover letter and contact information for 3 professional references.

ACMH is an equal opportunity employer and does not discriminate in employment decisions based on race, color, creed, gender, sexual orientation, gender identity or expression, national origin, age, genetic information, mental or physical disability, marital status, veteran status or citizenship.