Job Description
Overview
Provides, education, client advocacy, regular evaluation and feedback about clients on caseload. Also evaluates clients' eligibility for other social service programs. Alerts team members when follow-up is required and ensures efficient and successful access and linkage to the full array of community based services with the goal of client's successful completion of the care plan. Works under close supervision.
What We Provide
R eferral bonus opportunities
Generous paid time off (PTO) , starting at 20 days of paid time off and 9 company holidays
Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life and Disability
Employer-matched retirement saving funds
Personal and financial wellness programs
Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care and commuter transit program
Generous tuition reimbursement for qualifying degrees
Opportunities for professional growth and career advancement
Internal mobility, CEU credits, and advancement opportunities
Interdisciplinary network of colleagues through the VNS Health Social Services Community of Professionals
What You Will Do
- Uses rosters and meets with the team members to identify clients that require follow up and assistance.
- Reviews care plan with the client and care management team; notifies and assists the care management team of any immediate needs and risk factors and makes referrals to services to address such needs.
- Utilizes motivational interviewing techniques and skills to address medical and psycho-social health. Motivates and supports client to participate in their individualized care plan.
- Provides outreach via phone and in person community visits to clients to follow up on self-care, medication fills/refills, care plan engagement/adherence scheduled visits, and test results received from providers.
- Reinforces education provided by client’s medical providers related to the management of the chronic disease or conditions specified in their care plan; helps educate clients about conditions and self care/condition management.
- Provides health coaching and support for a caseload of assigned clients from initiation into program to completion. Works closely with the care management and team to discuss clients’ progress in plan and goals for completion. Prepares detailed, accurate and timely case notes and utilizes care management platform as required to note client progress and updates.
- Provides information and assistance through advocacy and education to client/family on availability and eligibility of entitlements and community based services. Assists with client navigation of health system. Arranges transportation and accompanies clients to facilities/agencies, as necessary.
- Works collaboratively with team members to provide outreach for and engage resistant/hard to reach clients with overdue screenings or upcoming appointments and /or who have been non-compliant with necessary treatment appointments.
- For Wellness Program:
- Uses motivational interviewing techniques and skills to identify substance use history and symptoms related to care plan.
- Provides escorts to visits in the community in an effort to increase participation in an adherence to Wellness Plan and related appointments.
- Provides self-management tools and reviews how to use those tools. Conducts voluntary Wellness Groups on site at WeCare. Facilitates periodic case record reviews and case conferences with all providers serving the client. Reviews new cases for completeness of documentation.
- Participates in special projects and performs other duties as assigned.
Qualifications
Education:
- High School Diploma or equivalent required
- Associate's Degree or Bachelor’s degree in a human services or related field preferred
Work Experience:
- Minimum of one year experience in care management, community health, social service, or medical practice preferred
- Effective oral/written/interpersonal communication skills required
- Basic computer skills required
- Bilingual skills may be required as determined by operational needs.
Compensation
$19.18 - $23.99 Hourly
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.
Job Tags
Hourly pay, Holiday work, Work experience placement, Immediate start, Flexible hours,