Care Manager - Adult Health Homes

The Care manager has overall day to day responsibility for coordinating the activities of the care team for clients with complex medical and/ or psychiatric co-morbid conditions and for facilitating clients’ access to the full range of medical and psychosocial services in an efficient and effective manner.

• Actively participates in multidisciplinary case conferences and projects, collaborating with community-based organizations to meet clients’ needs.
• Collaborates closely with the interdisciplinary care team, including PCP, psychiatrist, therapist, residential services, and substance abuse programs.
• Provides input for individualized care plans to providers, clients, and families.
• Identifies and resolves barriers to care with clients and engages those who have not met treatment goals.
• Monitors medication adherence, addresses barriers, and ensures current medication reconciliation.
• Responds to emergency room alerts, visits clients during admission, and participates in discharge planning and care transitions within 24 hours of hospital discharge.
• Ensures clients keep scheduled appointments and arranges preventive screenings based on evidence-based guidelines.
• Coordinates care between the client and extended care team to ensure the integrated care plan is executed.
• Regularly reviews client information to identify outreach needs, engages clients, and addresses quality of care issues.
• Provides or arranges self-management, wellness education, and peer support in the client's preferred language.
• Assists with benefits, entitlements, and housing applications, following up to ensure approvals.
• Complies with all government and funder regulations.
• Performs additional duties and initiatives as assigned by the Program Director.

• BA/BS degree required preferred master’s in social work (MSW).
• 1-2 years of experience in the health care slash social work case management discharge planning or third-party peer experience preferred.
• Bilingual Creole was Spanish preferred.
• Driver's license with vehicle preferred.​​​​​​

Benefits 

At HeartShare we offer a comprehensive benefit package based on full-time/part-time status. You can expect: 

• Rewarding Work in a team environment.
• Paid vacation, sick, personal days, and holidays.
• 403(B) retirement plans with employer contribution.
• Health, dental, vision and life insurance.
• Employee Assistance Program (EAP).
• Flexible spending account (Dependent Care, Medical, Parking, and Transit).
• Employee Appreciation Programs and Events.
• Tuition Assistance Program.
• Professional Development opportunities.
• Wellhub Discount
• Verizon Wireless Discount.
• BJs Membership discount.
• Discounts on Broadway tickets, movie tickets, theme parks, sporting events, gift certificates & more

HeartShare is an Equal Opportunity Employer (EOE). If you need to request accommodation during the recruiting process, please reach out to Leaves@heartshare.org.  

About HeartShare

Who WE ARE:

For over one hundred y