Evergreen Health

The Care Coordinator applies the essential activities of case management which include assessment, planning, coordination, monitoring and evaluation with the core components (Comprehensive Case Management, Care Coordination & Health Promotion, Comprehensive Transitional Care, Patient & Family Support and Referral to Community & Social / Support Services).

The Care Coordinator will be responsible for the following outcomes : Reduce utilization associated with avoidable and preventable inpatient stays, reduce utilization associated with avoidable emergency room visits, improve outcomes for persons with mental health illness and / or substance use disorders;

and improve disease-related care for chronic conditions.

As part of the Essential Functions for this role, the Care Coordinator :

• Completes a comprehensive health assessment / reassessment inclusive of medical / behavioral / rehabilitative and long term care and social service needs
• Consults with multidisciplinary team on client’s care plan / needs / goals
• Conducts outreach and engagement activities to assess on-going emerging needs and to promote continuity of care and improved health outcomes
• Consults with primary care physician and / or any specialists involved in the treatment plan
• Prepares client crisis intervention plan
• Coordinates with service providers and health plans as appropriate to secure necessary care, share crisis intervention and emergency information
• Link / refer client to needed services to support care plan / treatment goals, including medical / behavioral health care;

patient education, and self-help / recovery, and self- management.

Completes / revises an individualized patient-centered plan or care with the patient to identify patient’s needs / goals, and includes family members and other social supports as appropriate

Qualified Candidate will have a Bachelor’s degree in health, human or education services and one year of qualifying* experience or Associate’s degree in health, human or education services and one (1) year of qualifying* experience.

Qualifying* experience equals professional case management or care coordination experience with the following populations : persons with a chronic illness, and / or persons with a history of mental illness, homelessness, or chemical dependence.

Candidate must have a valid NYS Driver’s License and an insured, dependable car.

Job Type : Full-time (Part time may be available)

Required education : Bachelor’s (plus 1 year experience) ; Associates (plus 2 years experience)

Required experience : Care Coordination / Case Management; Working with clients experiencing chronic illness, homelessness, mental illness and / or chemical dependence

Additional requirements : Must have dependable, insured vehicle and NYS Driver’s License

What Evergreen Health Offers You :

• Remote Hybrid schedules may be available for this position
• Opportunities for overtime hours may be available for this position
• Dental and Vision coverage at no cost to you
• Paid Time Off package that equals 4 weeks of time in your first year
• 403b with a generous company match
• Paid parking or monthly metro pass
• Professional development opportunities
• Paid lunch breaks

Last updated : 2024-04-28