Senior Care Management Navigator (Bilingual Spanish Speaking)

What We Provide

• Referral bonus opportunities

• Generous paid time off (PTO), starting at20daysof paid time offand 9 company holidays

• Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life andDisability

• Employer-matched retirement saving funds

• Personal and financial wellness programs

• Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care

• Generous tuition reimbursement for qualifying degrees

• Opportunities for professional growth and career advancement

• Internal mobility, generous tuition reimbursement, CEU credits, and advancement opportunities

• Interdisciplinary network of colleagues through the VNS Health Social Services Community ofProfessionals.

What You Will Do

• Responsible for reviewing rosters and meeting with team members to identify clients that require complex and routine follow-up and assistance.
• Maintains expertise knowledge on product(s) and organization structure. Acts as a resource to member and client.
• Reviews care plan with the client/enrollee and care management team; notifies and assists the care management team of any immediate needs and risk factors and makes referrals to arrange services to address such needs.
• Motivates and supports client to participate in their individualized care plan by using motivational interviewing techniques and skills to address medical and psycho-social health.
• Provides outreach support via phone to clients/enrollees to follow up on their self-care, medication fills/refills, care plan engagement/adherence scheduled visits, and test results received from providers.
• Reinforces education provided by client's/enrollee's medical providers related to the management of the chronic disease or conditions specified in their care plan; helps educate clients/enrollees about conditions including but not limited to, self-care/condition management, program features, benefits, and admission requirements.
• Provides health coaching and support to assigned clients/enrollees from initiation into the program to completion. Works with the care management team to discuss clients'/enrollee's progress in plan and goals for completion. Prepares detailed, accurate, and timely case notes and utilizes care management platform as required to note client/enrollee progress and updates.
• Provides information and assistance through advocacy and education to client/enrollee/family/formal and informal caregivers on availability and eligibility of entitlements and community-based services. Assists with client/enrollee navigation of health system.
• Works collaboratively with team members to provide outreach and follow up with resistant enrollees with overdue screenings or upcoming appointments and /or who have been non-compliant with necessary treatment appointments. Remind them and schedules doctors/specialists appointments and transportation as necessary.
• Participates in initial and ongoing training to maintain mastery level of knowledge related to Community-Based Resources and new internal programs.
• Protects the confidentiality of member or client information and adheres to company policies regarding confidentiality.
• Ensures compliance with VNS Health policies and procedures as well as all Federal and State regulations.
• Ensures that relevant team members receive important client/member alerts, including visits, hospitalization admission/discharge information, and other urgent notifications.
• Supports the clinical team with any changes that will impact members in maintaining the most independent living situation possible; including but not limited to client/member alerts, visits, hospital admission/discharge information, and other urgent notifications.
• Participates in special projects and performs other duties as assigned.

Licenses and Certifications:
License and current registration to practice as a Licensed Social Worker in New York State preferred

Education:
Bachelor's Degree in Healthcare related field required

Work Experience:
Minimum two years experience in care management, community health, social service, or medical practice required

Effective oral/written/interpersonal communication skills required

Proficiency in MS Word, Excel and Teams required

Bilingual skills may be required as determined by operational needs