Health Home Care Mgr, Psych

University of Rochester   •  

Rochester, NY

Industry: Education


Less than 5 years

Posted 99 days ago

This job is no longer available.

General Purpose:

Provides professional comprehensive care management services to patients of the Strong Behavioral Health, Care Management Program. Collaborates with health, behavioral health and social service providers and is responsible for the development and management of service plans for patients enrolled in a NYS-licensed Health Home who have need for the most complex, high utilizing and costly services and may be at high risk for under-utilizing services.

Specific Responsibilities:

The Care Manager-carries a caseload of assigned clients

Under general direction and with considerable independence, performs complex care management services consistent with NYS Regulations and Policy for the provision of Health Home Services. Establishes and maintains cooperative working relationships with community providers and resources to obtain needed services and support for enrolled patients. Utilizes community and family resources to create sustainable support systems for patients. Reviews and discusses plan with patient, focusing on linking individuals to clinical and social services with system and community providers.

  • Coordinates outreach and engagement activities focused on finding, connecting and retaining patients in Health Home Care Management Services.
  • Conducts a comprehensive care needs assessments for Health Home enrollees that includes a delineation of medical/ behavioral health and social service needs.
  • Develops a comprehensive Care Management Service Plan using person centered practices for each patient. Reviews and discusses plan with patient, focusing on linking the individual to needed clinical and social services with system and community providers.
  • Monitors utilization of services and encourages enrollees to follow treatment recommendations, ensures that care is assessable, attended and effective. Monitors the use of costly Emergency and Inpatient services, supports patient in keeping all aftercare appointments and addressing barriers as needed.
  • Completes documentation of services provided in eRecord in compliance with hospital policy and Health Home regulation, performs periodic reviews of Comprehensive Service Plans as prescribed by NYS DOH. Assists with record reviews and quality initiatives.


Bachelor’s Degree in an appropriate human services field required and 4 years’ direct experienceworking with individuals diagnosed with Serious Mental Illness (SM!); or an equivalent combination of education and experience. Must possess and maintain a valid New York State License, have a satisfactory driving record and have access to an automobile.