Senior Care Coordinator - Health Homes

The person filling this position is expected, under general supervision, to: (1) aid individuals and/or families requiring social service assistance;(2) Comply with any and all Federal, State, City and CAMBA security and privacy polices intended to protect the security and privacy of individually identifiable health information.(3) Locate and make use of appropriate community resources for clients; (4)Practice Universal Precautions/Standard Protocol & Procedures (5)Evaluate actual living conditions of clients though home visits. 

• Maintain professional relationships with clients and client confidentiality. 
• Review all documentation establishing clients' eligibility for program and make file copies (e.g. Medicaid status and confirmation of HIV status). 
• Assist clients in completing all CAMBA intake applications and forms. 
• Create and maintain client files. 
• Manage a caseload of approximately 55 clients. 
• Conduct initial intake or assessment of clients and clients' families and/or periodic reassessments.  
• Interview and assess applicants for services, develop service plans and goals, and support clients in implementing those plans. 
• Conduct case conferences prior to finalizing all assessments / reassessments. 
• Follow up with clients and referral organizations regarding client contact and progress with referral organization. 
• Work with clients to break through barriers to client goals and to assist clients in advocating themselves and in moving toward self-sufficiency. 
• Recommend and implement strategies to persuade clients to participate more fully in this process.  
• Monitor clients' progress toward their service plans goals via regularly scheduled telephone contact and/or face-to-face home and office visits, and document via service plan outcomes and detailed progress notes (i.e. time of service, type of service, etc.). 
• Recommend closing of cases in which clients have: (a) achieved primary goals and have maintained stability for a period of months; or, (b) have not demonstrated a willingness to participate in the process (lost-to-service); or, (c) have become ineligible for services (e.g. moved out of area, change in Medicaid status). 
• Provide all required information for weekly/monthly/quarterly/annual reports (e.g. # of clients in managed care programs, # of clients housed, etc.). 
• Act as client liaison/client advocate with outside organizations regarding such matters as education, healthcare, housing, legal issues, entitlements, etc. 
• Escort clients to appointments (educational, medical, social service, etc.). 
• Follow up with clients for a period after successful completion of their primary goals to ensure client stability. 
• Plan, coordinate and facilitate social/peer support events, including group facilitation for clients. 
• Prepare marketing materials for the program. 
• Input client data and client progress information into an automated database. 
• Reach out and market the program to the community to recruit clients. 
• Prescreen clients over the telephone for eligibility and may schedule intake appointments. 
• Assist clients in completing applications for benefits and entitlements and may process applications on clients' behalf.  
• Evening or weekend availability may be required for special projects, audits, or early field work. 
• CAMBA Health Link follows a hybrid schedule of two remote (2) and three office (3) days, with possible field work on remote days, and office days may increase based on performance. 
• Other duties as assigned. 

• Bi-lingual English with any one of the following languages: Spanish or Haitian-Creole preferred. 

• Bachelor’s degree (B.A. or B.S.W) and two years of relevant experience, or 
• Bachelor's degree (B.A. or B.S.W.) and one year of experience within CAMBA's Health Link program.