Case Manager Care Management

VALERIE FLORES

EXPERIENCE

Northwell Health Homes

September/2019-present

Case Manager Coordinator

Job Summary

The Care Coordinator will assist the care management team through direct and indirect response to the health care management issues and needs of CS-HHC patients/clients. Care Coordination/Management will include assisting Medical Providers, Behavioral Health Providers, Complex Care Managers, and Interdisciplinary Team members with clinical support services and data management. In addition they will assist clients with entitlement, resource and housing issues; referral management and follow-up; collection, recording, and review of client data; office, phone, clerical and other support services to care management team as needed.

CS-HHC’s Expectations of all Employees

Adheres to all CS-HHC Policies and Procedures

Conducts self in a manner that represents CS-HHC’s Values at all times

Maintains a positive and respectful attitude with all work-related contacts

Communicates regularly with supervisor about Departmental and CS-HHC concerns

Consistently reports to work on time, prepared to perform the duties of the position

Meets productivity standards and performs duties as workload necessitates

Essential Duties and Responsibilities

Works to provide and improve continuity the patient experience before, during, and following engagement within the health system.

Interacts with patients and patient caregivers as appropriate to ensure continuity of care, patient adherence to care plans, and identification of barriers preventing adherence to care plan.

Coordinates care with other members of the care team to overcome any identified financial or social barriers that inhibit patients’ medical care.

Provides care coordination/management services to individual clients, groups of clients, and/or families in the CS-HHC setting or general community, in a manner that is consistent with professional standards

Records referral follow-up activity, progress and outcomes for the medical record.

Gathers records and communicates referral and community resource developments.

Attends and participates in team conferences as needed

Assists client and care management team in obtaining and maintaining insurance, entitlement and other resource authorizations as needed to provide core health and behavioral health services and referral services

Works with care management team to identify client/patient need for advocacy in the area of accessing health and behavioral health systems and services, entitlements and community resources

Documents and communicates client needs to care management team

Works with clients and outside agencies to help address client medical/social service needs as per

care management plan

Provides support services for the care management team as needed

Educates patients regarding how to navigate throughout the health system.

Performs all other duties as assigned by the Director of Care Coordination.

Harbor Terrace Assisted Living Program June.2018-September 2019

Case Manager

The Case Manager is responsible for caseload or residents/clients: monitoring their daily activities, assisting them with employment, housing, transitional, and other discharge planning requirements.

Handles initial resident orientation to program and expectations and develops and monitors Individual Program Plan for residents on caseload.

Meets regularly with each resident to discuss progress with program requirements, personal goals, program compliance, review of finances (wages, subsistence payment, budget, savings, and any financial obligations) and discusses, reviews and helps with weekly schedules, passes, and itineraries.

Communicates with contracting and other relevant agencies to regarding various aspects of Individual Program Plans.

Maintains ongoing communication with service providers and family members, and Director as relevant to the continued progress of each resident on caseload.

Schedules regular resident counseling sessions and supervises, sets limits, controls, and structures accountability of residents.

Provides timely information to appropriate personnel for coordination of services and for reporting purposes.

Completes all required paperwork for each resident on caseload.

Participates in on-call rotation according to a determined schedule.

Attends necessary meetings, conferences, and training within CRJ and with outside providers.

Jewish Board (Green Key Resources) Sept. 2016 – April.2018

Milieu Counselor

Provide group therapy

Assist with activities of daily living and recreation activities

Federation of Organizations Aug. 2016 – May/2018

Care Coordinator

Assist clients in applying for housing

Link clients to their entitlements such as social security, HRA and Medicaid

Accompany clients to appointments

Assist in providing home care services and medical transportation

Assist clients with finding medical specialists

Mercy Drive Inc. Sept. 2015 – Aug. 2016

Medicaid Service Coordinator

Coordinate and manage the implementation of Home & Community Based Services (HCBS) under New York OPWDD Waiver

Develop Individualized Service Plans (ISP)

Monitored client’s progress within each service, and link clients to additional community services that could meet their medical/educational needs

City of New York Human Resources Administration Apr. 2013 – Apr. 2014

Fraud Investigator: Level One

Conducted investigations of applicants for eligibility of social service benefit programs

Made field visits to verify city residence for agency clientele

Gathered evidence, conducted interviews, and reviewed public and private records

Issued collateral clearance to obtain information for internal actions

Wrote reports summaries and prepared/maintained evidentiary materials

Little Flowers Children Services Aug. 2011 – Apr. 2013

Case Planner

Coordinated services for at-risk youth and adults mandated under NYS Social Service Law (disabled and victims of domestic violence)

Formulated treatment plans, preformed outreach, and advocated in New York State Family Court on behalf of the client

Department of Human Services Sept. 2000 – Feb. 2010

Case Manager

assisted service plan for the elderly

carried caseload of foster care children who were disabled and victims of abuse

Updated progress notes in CONNECTIONs system (launched FASPs)

Assisted clients with evictions and attended hearings

Provided extensive counseling and kept accurate records of client interviews

Revised the status of the individual's service plan

Obtained information regarding eligibility

Scheduled and followed through with field visitations to applicants, clients and agencies following proper procedure governing notice

Formulated and revised service plans of clients by analyzing personal social data, conferring with medical/psychiatric/other relevant professional consultants as required

Maintained a professional disposition and followed agency procedure

Extensive usage of HALO/CTR and other electronic information storage systems

Received the "Employer Recognition Award 2005" for outstanding performance

Department of Social Services Dec. 1999 – Sept. 2000

Eligibility Specialist

Evaluated clients and applications for eligibility for food stamps

Made outgoing calls to clients to request proper documentation needed for approval

Assisted consumers with filing in food stamp applications

Maintained positive work relations with all personnel

Life Spire Oct. 1998 – Dec. 1999

Counselor

Trained consumers on travel arrangements

Assisted consumers on various activities such as reading and managing finances

Taught consumers how to prepare their own meals along with any other assistance needed

Counseled on a daily basis on independent living

EDUCATION

Boricua College Sept. 1992 – Jun. 1995

Bachelors in Social Sciences

SKILLS

Bilingual Spanish

Proficient with Microsoft Word/Excel

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