Housing Taskforce Care Manager

MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens, and Staten Island through a comprehensive list of products, including New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, and others. As a wholly‑owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlusHealth’s network includes over 27,000 primary care providers, specialists, and participating clinics. For more than 40 years, MetroPlusHealth has been committed to building strong relationships with its members and providers. Position Overview Under the direction of the Manager of Housing Taskforce, the Housing Taskforce Care Manager provides critical support to members experiencing homelessness to optimize their health care and delivery of care experience with expected cost savings due to improved quality of care. The role also supports formerly homeless members who are transitioning to permanent housing through holistic, focused engagement and a comprehensive understanding of the member’s physical, behavioral, and social needs—including environment, providers, support system, and available resources. The Care Manager is a creative, efficient, and resourceful problem‑solver who works as part of a dynamic team through telephonic outreach, field work in members’ homes, facilities, and provider offices. The Care Manager serves as a member’s advocate and accompanies the member throughout their care journey, assisting with medical and behavioral health stabilization so that members can maintain or improve their day‑to‑day functioning. This is a hands‑on, intensive position that is a hybrid remote/office/field role requiring field‑based work and travel within the MetroPlusHealth service area. The Care Manager may need to physically meet members where they are to gain a deeper understanding of their situation and needs. Duties & Responsibilities Assess and address member’s problems and needs: clinical, psychosocial, financial, and environmental. Provide services to members of varying age, clinical scenario, culture, financial means, social support, and motivation. Engage members in a collaborative relationship, empowering them to manage their physical, psychosocial, and environmental health to improve and maintain lifelong well‑being. Support members during the transitional period from shelter to permanent housing, and once they are housed to settle into their new living situation. Assess and address risks and gaps in care. Maximize member’s access to available resources. Develop a member‑centered plan of care with input from the member, caregivers, and health care providers, integrating concepts of cultural sensitivity and privacy practices. Communicate the plan of care to the Primary Care Physician initially and provide updates as needed. Ensure member’s understanding regarding language barriers, stress reaction, or cognitive limitations/barrriers through verbal and nonverbal techniques. Train member on relevant chronic diseases, preventive care, medication management (medication reconciliation and adherence), home safety, and related topics. Provide complex care management, including ensuring access to care, reducing unnecessary hospitalizations, and appropriately referring to community supports. Advocate for members by assisting them to address challenges and make informed choices regarding clinical status and treatment options. Develop collaborative relationships with clinical providers and facility staff. Employ critical thinking and judgment when dealing with unplanned issues. Use data as a tool in tracking and trending outcomes and clinical information. Maintain accurate, comprehensive, and current clinical and non‑clinical documents. Comply with all initial, annual, and other mandatory trainings, organizational and departmental policies, and procedures, and actively participate in the evaluation process. Maintain professional competencies as a Housing Taskforce Care Manager. Conduct other duties as assigned by the Manager of Housing Taskforce. Minimum Qualifications Master’s Degree in Social Work required. 3 years of prior experience in care management in a health care and/or managed care setting, or other relevant experience in Social Work or Case Management. Proficiency with computers and navigating multiple systems and web‑based applications, including Microsoft Word, Excel, Teams, PowerPoint, Outlook, and various portals. Ability to proficiently read and interpret medical records, claims data, pharmacy and lab reports, and prescriptions. Ability to work closely with members and caregivers. Significant experience working with clients around homelessness, addictions, mental health, entitlements, and housing. Knowledge of members’ rights and responsibilities as tenants. Experience working on‑site in a behavioral health practice setting. Bilingual (English/Spanish) preferred. Licensure And/or Certification Required Valid unrestricted NYS license as LMSW or LCSW. Professional Competencies Confident, autonomous, solution‑driven, detail‑oriented, high standards of excellence, non‑judgmental, diplomatic, resourceful, intuitive, dedicated, resilient, and proactive. Strong verbal and written communication skills including motivational coaching, influencing, and negotiation abilities. Time management and organizational skills. Strong problem‑solving skills. Ability to prioritize and manage changing priorities under pressure. Ability to travel within the MetroPlusHealth service area, including home visits to members, facility visits to clinical providers, and visits to community, faith, and other social service‑based agencies. Eco‑Friendly Hiring Note: This position is offered in compliance with equal opportunity employment laws. EEO Statement: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, or protected veteran status. #J-18808-Ljbffr NYC Health + Hospitals