Care Coordination Floater
Company: Horizon Health Services
Posted on: April 8, 2021
If you are a job seeker with a disability and require a
reasonable accommodation to apply for one of our jobs, you will
find the contact information to request the appropriate
accommodation by visiting the following page: Description Are you
looking to start or continue your career within the human services
field? Do you want to work in a role where you will be able to help
our community daily? Apply to be a Care Coordinator today! "The
best thing about coming to work at Horizon Health Services is
knowing that I am given the opportunity to make a difference within
the community, and, knowing that I am supported by my amazing
team!" What will my day look like? We know that helping our
community is your priority! Horizon wants to make sure that you are
can do that with ease by making sure you are supported. From a
great onboarding experience to continuous training you will always
have the resources you need to be successful! Here is some more
information about the job that you should probably know---
- Coverage of a caseload that is weighted at a total of 100+ for
staff that may be on medical leave or for staff vacancies. Members
receive a minimum of one or two monthly face to face contacts,
depending on their status, as well as one or two monthly
provider/HCBS/MCO/family contact. Additional contact may be
necessary and is at the discretion of management.
- Willing to make home visits to members in potentially
undesirable locations in various home environments.
- Successfully complete the HARP Assessment training in the
Uniform Assessment System for New York (UAS-NY). Performs HARP
assessments/reassessments; maintains an active Health Commerce
System (HCS) account.
- Promote a team approach within the Care Coordination
- Interviews members to assess member needs, prioritize needs,
identify barriers in addressing needs, and strategize to overcome
- Assist members in the development of the care plan,
self-management goals and strategies; documents them in the
Electronic Medical Record (EMR).
- Assist member with coordination of appointments including, but
not limited to, scheduling, rescheduling, providing appointment
reminders and arranging transportation.
- Works closely with the interdisciplinary care team including
PCP, psychiatrist, therapist, residential services, substance abuse
treatment program, etc.
- Develops interdisciplinary care plan and other case management
tools by participating in meetings; coordinating information and
care requirements with other care providers; resolving issues that
could affect smooth care progression; encouraging peer support;
providing education to others regarding the care management
- Monitors the delivery of HCBS services to ensure members are
following through with goals identified in their care plans.
- Attend clinical meetings to review members' utilization of
- Complete case record reviews.
- Updates HARP Plan of Care once notice of decisions are
received, final approval, every 6 months or if a significant change
has taken place.
- Ensures all documentation of member interaction is completed
timely in the EMR
- Completes other required paper work such as mental health and
drug court reports, consents, etc.
- Respects members by recognizing their rights; maintaining
- Maintains quality service by establishing and enforcing agency
- Maintains member care database by entering new information as
it becomes available; verifying findings and reports; backing up
- Maintains professional and technical knowledge by attending
educational workshops; reviewing professional publications;
establishing personal networks; benchmarking state-of-the-art
practices; participating in professional societies.
- Conducts home visits and participates in member appointments
and case conferences in the community with other providers.
- Researches community resources and government benefit programs
to determine eligibility criteria, provide appropriate referrals,
and perform follow up activities for referrals.
- Outreaches to members to facilitate keeping scheduled
appointments; arranges for metabolic and periodic preventive
screening, per evidence based guideline standards and review
results with members and their family.
- Coordinates services between members and extended care team
providers to ensure that integrated care plan is fully
- Regularly reviews member information from care team to identify
members requiring outreach and engagement.
- Assist members in identifying the necessary skills to promote
self-sufficiency, medical adherence, and the ability to access and
maintain community resources on their own.
- Reassess members annually by completing the Health Home
Comprehensive Assessment located in our EMR system.
- Utilize MAPP, HEALTHeLINK, EPACES, GSI, Netsmart, Cerner, or
any other identified programs or EMRs to obtain pertinent
information for proper coordination of care
- Other duties, as assigned by supervisor and as program needs
change Side Note: You must possess a clean NYS driver's license and
have reliable transportation to travel locally on a regular basis.
Why do I want to work for Horizon? Besides the fact that we have
been named a Best Place to Work for 12 (yes 12!) years in a row? At
Horizon you are able to come to work knowing that you are making a
difference in someone's life. You will also work around people that
want to make a difference just as much as you!
- Collaboration. Not only will you be able to work with other
Care Coordinators, you will also be able to work with counselors on
how to best help and support our patients. The more the merrier,
- Various training opportunities. Who doesn't love professional
development? Horizon University offers more clinical and
nonclinical trainings than we can count. There's always something
new to learn here.
- Seasonal employee outings. This gives you built in time within
your week to enjoy some self-care, wellness, and team
- Summer hours. Every Friday in the summer you will be able to
start your weekend at 1pm. Who doesn't want to extend their weekend
by a half a day?! What has prepared me for this opportunity?
- A bachelor's degree in any of the following: child & family
studies, community mental health, counseling, education, nursing,
occupational therapy, physical therapy, psychology, recreation,
recreation therapy, rehabilitation, social work, sociology, or
speech and hearing; OR a NYS licensure and current registration as
a Registered Nurse and a bachelor's degree; OR a--bachelor's level
education or higher in any field with two years of experience
working directly with persons with behavioral health diagnoses; OR
a credentialed Alcoholism and Substance Abuse Counselor (CASAC)
- Two years of experience providing direct services to persons
diagnosed with mental disabilities, developmental disabilities,
alcoholism, or substance abuse OR linking persons who have been
diagnosed with mental disabilities, developmental disabilities,
alcoholism or substance abuse to abroad range of services essential
to successfully living in a community setting. Please note
a--Master's degree in a related field may substitute for one year's
experience.-- Location Care Coordination has merged Genesee,
Niagara and Erie County teams into a new facility located in 1000
Young Street in Tonawanda, NY. Within this area you would
specifically be responsible for the (Genesee, Niagara or Erie)
county members. Hours Monday through Friday-no weekend hours in
this position! This position has a schedule from 8:00 a.m.-5:00
p.m. but we are flexible and want to work with your schedule as
well! Equal Opportunity Employer/Protected Veterans/Individuals
with Disabilities The contractor will not discharge or in any other
manner discriminate against employees or applicants because they
have inquired about, discussed, or disclosed their own pay or the
pay of another employee or applicant. However, employees who have
access to the compensation information of other employees or
applicants as a part of their essential job functions cannot
disclose the pay of other employees or applicants to individuals
who do not otherwise have access to compensation information,
unless the disclosure is (a) in response to a formal complaint or
charge, (b) in furtherance of an investigation, proceeding,
hearing, or action, including an investigation conducted by the
employer, or (c) consistent with the contractor's legal duty to
furnish information. 41 CFR 60-1.35(c)
Keywords: Horizon Health Services, Tonawanda , Care Coordination Floater, Other , Tonawanda, New York
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