Postgraduate Center For Mental Health
Provides mental health services, training, and research to promote well-being and recovery.
Care Coordinator
Coordinate care for members with chronic health/behavioral issues, providing access and support.
Job Highlights
About the Role
As part of the Care Coordination team and under the Program Supervisor’s guidance, the Care Coordinator supports NYC Medicaid beneficiaries with chronic health or behavioral health conditions through the Health Home model. The role involves addressing member needs, updating care plans, and conducting outreach between visits to promote wellness, self‑management, and reduce unnecessary emergency department use or hospitalizations. The coordinator works closely with physicians, mental‑health and substance‑abuse providers, families, and community agencies, ensuring members receive necessary services and resources. They also maintain organized documentation, assess barriers to care, and manage wrap‑around resources to facilitate comprehensive, patient‑centered care. • Manage a caseload of 30‑35 Medicaid members, maintaining monthly contact and increased outreach for new or high‑risk individuals. • Conduct member engagement via face‑to‑face, mail, electronic, and telephone communication after handoff from Outreach Team. • Coordinate communication with primary/specialty physicians, mental health and substance‑abuse providers, families, and community agencies on behalf of members. • Maintain accurate documentation, records, statistics, and reports in compliance with policies. • Perform initial and periodic needs assessments, identifying barriers such as transportation, social supports, language, literacy, and cultural preferences. • Assist members in developing, understanding, and following individualized care plans, tailoring communication to health‑literacy levels. • Arrange transportation, schedule appointments, and accompany members to healthcare visits as needed. • Identify and refer members to community‑based resources, managing referrals, access, engagement, follow‑up, and coordination of services. • Support members in managing daily health‑related routines and integrating strengths while addressing barriers. • Re‑engage members who miss appointments or discontinue treatment, providing continuity of care. • Provide crisis intervention and follow‑up, advocating for resolution of member crises. • Monitor and ensure continuity of member entitlements, insurance, and benefits. • Collaborate with interdisciplinary professionals to evaluate medical and behavioral health needs. • Manage wrap‑around funds, metro cards, and member purchase checks, obtaining necessary approvals aligned with member goals.
Key Responsibilities
- ▸care coordination
- ▸member outreach
- ▸needs assessment
- ▸documentation
- ▸referral management
- ▸fund management
What You Bring
• Required: Bachelor’s degree and at least two years of direct human‑services experience with individuals facing chronic health or behavioral health disorders.
Requirements
- ▸bachelor's
- ▸2 years
- ▸human services
- ▸behavioral health
Benefits
The position is a full‑time Care Coordinator based at 2681 Marion Avenue Residence in the Bronx, NY, offering a salary range of $42,000‑$45,000 and day shifts. Candidates must hold a four‑year degree.
Work Environment
Onsite