Open Door Family Medical Centers has been serving low-income, under-served residents and those lacking access to health care in the communities of Westchester and Putnam counties for more than 40 years, providing high quality primary health care and human services at affordable prices. Open Door’s nationally renowned Community Health Center sites, mobile dentistry units, school-based health programs, and its family practice residency training program, deliver exceptional value to both patients and the communities it serves, dedicated to engaging men, women and children in healthier lifestyles and creating healthier communities.

 This year, Open Door will be the medical home for more than 57,000 patients, providing more than 300,000 visits. Our family medical services include primary medical care, dentistry, mental health, optometry, podiatry, and women’s health in Ossining, Sleepy Hollow, Mamaroneck, Port Chester, Mount Kisco, and Brewster, NY.

Open Door believes that health is a right, not a privilege, with primary care to be affordable and delivered cost-effectively. We believe that healthy individuals and families are the foundation of a caring society, and that those empowered to lead healthy lives contribute significantly to our communities’ success. For additional information, please, visit www.opendoormedical.org.

Open Door is seeking a Care Manager, Adult Health Home Program for its Family Medical Center in Ossining, NY. The Care Manager will report to the Assistant Director of the Health Home Program, who is based in Ossining. The Health Home program is a New York State program for individuals on Medicaid who have chronic health conditions. The goal of the program is to improve health outcomes and reduce emergency room and hospital visits. For more about the Health Home program, please see: https://www.health.ny.gov/health_care/medicaid/program/medicaid_health_homes/

All Open Door Family Medical Centers are located in Westchester and Putnam counties located just North of New York City, which offer excellent schools, easy access to a multitude of outdoor activities, and superb transportation connections to New York City.

Responsibilities

• Outreach individuals and engage them into the Health Home program
• Conduct annual assessments to identify Health Home enrollees’ individualized needs related to psychosocial wellbeing, physical health and the social determinants of health; utilize standardized assessment tools; monitor needs on and ongoing basis
• Based on the findings from the annual assessment, collaborate with Health Home enrollees to develop a plan of care
• Engage Health Home enrollees in the goal setting process and utilize Motivational Interviewing and other techniques to assist in goal achievement
• Coordinate and arrange for the provision of medical, behavioral health and other relevant services
• Accompany Health Home enrollees to appointments as needed; model and coach on medical/behavioral visit navigation with the aim of empowering Health Home enrollees to become independent, effective health care consumers
• Conduct home visits as needed • Support Health Home enrollees in adherence to treatment recommendations from medical and behavioral health providers
• Provide psychoeducation using one-on-one teaching, written and printed materials as well as computer and video instruction approved by the primary care team to assist with Health Home enrollees’ understanding of physical and behavioral health conditions and treatments
• Link Health Home enrollees to internal and external peer supports, support groups and self-care programs to increase knowledge about their disease(s), engagement and self-management capabilities, and to improve adherence to prescribed treatment
• Identify available community-based resources and actively manages appropriate referrals, access, engagement, follow-up and coordination of services
• Promote evidence-based wellness and prevention by linking health home enrollees with resources for smoking cessation, diabetes, asthma, hypertension, self-help recovery resources, and other services based on individual needs and preferences
• Discuss advance directives and health care proxies with enrollees and their families or caregivers
• Retain Health Home enrollees in care over time
• Maintain a caseload of 50 individuals
• Perform duties in accordance with established clinic policies and procedures, objectives, quality improvement activities, safety, environmental and infection control standards
• Travel as required to community based meetings, medical/behavioral health provider sites and meetings with Health Home enrollees
• Maintain electronic medical records in compliance with Open Door’s standards
• Complete all documentation as required for the Health Home programs, including data entry into New York State data portal
• Represent Open Door at community outreach activities

Requirements

 Master’s Degree preferred; candidates with a Bachelor’s Degree and solid work experience will be considered as well

• Degree in Social Work or social sciences preferred; other degrees with relevant experience will be considered • Fluency in both English and Spanish
• At least two years’ experience in healthcare and/or social services settings
• Proficient in MS Office applications, including Excel
• Passionate about providing high quality care to low-income, under-served residents and those lacking access to health care
• Patient-centric and engaging with empathy, excellent active listening and communication skills
• Comfortable providing direct patient care to patients of all ages with chronic medical and behavioral health needs
• Competence working with culturally diverse patient and staff populations
• Able to navigate healthcare and community settings as well as patients’ natural settings (i.e. place of residence)
• Focused on collaborative team-based care
• Responsive and comfortable working in a fast-paced, high-accountability environment • highly organized, self-directed, able to multi-task and flexible
• Effective in problem solving • Excellent judgment and ability to prioritize resources where they will be most useful
• Engaged in learning and continuous quality improvement
• Outstanding written and verbal communications skills with a strong ability to exchange information on factual matters
• Must have valid NYS driver’s license and daily access to car

There are many fantastic benefits to a career at Open Door Family Medical Centers. In addition to working to effect positive change in the health and lives of thousands residents of Westchester and Putnam counties, Open Door offers its employees a stimulating, diverse and team-based work environment with comprehensive benefits including medical, dental, life insurance, flexible spending accounts, 403(b) and 401(k), generous paid time off, onsite Wellness facilities, and educational assistance. Aside from excellent benefits, we offer a competitive salary and annual bonuses based on patient care.

At Open Door, we enjoy working in a team-based, patient-centered environment and value the benefits of a diversified workplace that values our patients and the communities we serve.

If you want to make a difference in the lives of thousands of patients in the health of our communities of Westchester and Putnam counties, and if the position speaks to your capabilities, experience and commitment to improve the health of our communities, please submit your resume and cover letter with salary requirements, please, insert Care manager, Adult Health Home Program in the subject line.

 Qualified candidates will be contacted by phone and/or email.

 Open Door is an Equal Opportunity Employer

To apply please follow the link indicated below:

https://workforcenow.adp.com/mascsr/default/mdf/recruitment/recruitment.html?cid=1f86e9bf-7fd0-452e-aef3-8592b2c3a039&jobId=264450&lang=en_US&source=CC2&ccId=19000101_000001