HEALTH HOME CARE MANAGER-OUTREACH SPECIALIST - Sjhsyr : Job Details

**Health Home Care Manager-Outreach Specialist**

Location Syracuse, New York, 13203 Category Accountable Care Job Id 00335711 JOB DESCRIPTION ****Employment Type:****

Full time****Shift:****

****Description:****

Mission Statement **:**

We, St Josephs Health and Trinity Health, serve together in the spirit of the Gospel as a compassionate and transforming healing presence within our communities.

Vision:

To be world-renowned for passionate patient care and outstanding clinical outcomes.

Core Values:

In the spirit of good *Stewardship,* we heal by practicing *Justice* in fostering right relationships to promote common good, *Reverence* in honoring the dignity of every person, *Excellence* in expecting the best of ourselves and others; *Integrity* in being faithful to who we say we are.

**POSITION SUMMARY:**

Provides a range of client centered services that link clients with health care and behavioral health treatment as well as other psychosocial services as dictated by plan of care. Responsible for balancing a partial caseload and conducting outreach and enrollment activities (mailings, phone calls, face to face visits). Engage and potentially enroll clients on-site at locations on campus, as needed. Provides a network wide focus to the coordination and management of client care. Collaborates with additional system resources through an integrated care approach for individuals attributed through the Accountable Care Organization or Value Based Payment agreements. Works closely with family members when appropriate and all service

providers to ensure that clients needs in medical, behavioral and psychosocial domains are met and maintained.

**EDUCATION, TRAINING, EXPERIENCE, CERTIFICATION AND LICENSURE:**

Bachelors degree in appropriate discipline with one to two years progressive experience or an Associates degree with a minimum of four years experience in the field is acceptable. Previous discharge planning, counseling, home care, and substance abuse treatment experience is desired.

**SPECIAL EQUIPMENT, SKILLS OR OTHER REQUIREMENTS:**

Organizational, management and leadership skills. Oral and written communication skills. Demonstrated ability for problem solving and conflict management.

**WORK ENVIRONMENT AND HAZARDS:**

Exposure Class I or II, service specific various, depending on service limited exposure situations which could cause serious illness or injury. May involve exposure to blood, body fluids, excretion or secretions.

**PHYSICAL DEMANDS:**

Standing, walking and driving.

**WORK CONTACT GROUP:**

All services medical staff, patients, visitors, contractors, vendors and various regulatory and professional agencies.

**SUPERVISED BY:** Coordinator and Manager

**SUPERVISES:** None

**CAREER PATH:** Manager, Health Home

**GENERAL PERFORMANCE CRITERIA: Health Home Care Manager**

**EXPECTATIONS**

**Exceeds Meets Below**

* Responsible for outreach and enrollment activities (mailings, phone calls, face to face visits) on identified population of clients specific to on-site locations (i.e. main hospital, SJ practices, etc)

* Coordinates / facilitates client care needs in behavioral, medical and psychosocial areas.

* Collaborates with all relevant service providers to eliminate any barriers to efficient care delivery in the appropriate setting.

* Effectively communicates to clients and family members related to establishment of plan of

care and its progression through various stages of care management.

* Adhere to expectations set forth by Health Home Leadership (minimum 80% of assigned caseload receives a billable core service)

* Provides education to clients and their families related to medical, behavioral health and psycho social issues that affect their well-being.

* Develop strategies to address all identified performance measures for clients attributed through the ACO or VBP arrangements.

* Document all productivity and billing activities into Epic, and manage self-tracking via Microsoft Excel

* Uses health information technology to link services.

* Use own vehicle for outreach/enrollment activities as needed

* Adheres to hospital confidentiality statement.

**Trinity Health's Commitment to Diversity and Inclusion**

Trinity Health employs about 133,000 colleagues at dozens of hospitals and hundreds of health centers in 22 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.

Trinity Health's dedication to diversity includes a unified workforce (through training and education, recruitment, retention and development), commitment and accountability, communication, community partnerships, and supplier diversity.