Care Manager

Community Health Action of Staten Island (CHASI)

About the organization

Community Health Action of Staten Island (CHASI) drives dramatic improvements in the health of New Yorkers by feeding people who are hungry, healing families broken apart by violence, and bridging the gaps between people and the compassionate health care they deserve. CHASI serves the most vulnerable individuals, families, and communities with critical services and programs. CHASI provides outreach, education, prevention, and direct support services for populations most affected by health disparities – the poor and working poor, low income people with chronic illnesses, persons with criminal justice involvement, substance users, domestic violence survivors, people of color, and the LGBTQ community.


The Health Home program works with individuals on Medicaid who have one or more chronic illnesses to access health care and service providers with the goal of improving health outcomes. The Health Home Care Manager will be responsible for providing support to clients with a high need for clinical and support services.



Utilizes approved Health Home clinical tools and technology to prepare initial and ongoing clinical and psychosocial assessments of service needs of identified clients. Confirms acuity level of identified client and tailors care plan accordingly, reassessing as needed.
Develops, coordinates and integrates a coordinated care plan in cooperation with the client, the client’s family, and/or the other providers serving the patient. Updates plan at specified intervals, and as needed based on changes in client’s condition / circumstances.
Participates in integrated care efforts with all providers known to the client to monitor the treatment plan and treatment progress.
Performs and maintains effective care management for a caseload of clients, as assigned, from assessment to discharge.
Tracks/ monitors client progress and produces/maintains detailed, accurate and timely case notes.
Facilitates periodic case record reviews and case conferences with all providers serving the client.
Reviews new cases for completeness of documentation.
Provides linkage, coordination with, referral to and follow-up with appropriate ongoing service providers.
Attends planning meetings with service providers to coordinate service plans. Works effectively with interdisciplinary team of providers including PCP, substance abuse treatment, residential, hospital discharge planners, etc., to coordinate care delivery between all linked providers and client.
Maintains updated case records through health home EMR, and coordinates effective electronic communication throughout all provider databases, as needed. Maintains case records in accordance with health home policies/procedures, agency standards and regulatory requirements.
Participates and consults with team supervisor in case conferences, staff meetings, and discharge planning meetings to determine if client requires an alternate level of care or is appropriate for discharge.
Performs other duties and participates in special projects, as required.
Align all activities with CHASI’s mission, core values, and culture
Other duties as assigned



Education: A bachelor’s degree in any of the following: child & family studies, community mental health, counseling, education, psychology, rehabilitation, social work, sociology, or speech and hearing; OR a Bachelor’s level education or higher in any field with five years of experience working directly with persons with behavioral health diagnoses or chronic health conditions; OR a Credentialed Alcoholism and Substance Abuse Counselor (CASAC).
Two years of experience (a Master’s degree in a related field may substitute for one year’s experience) in providing direct services to persons diagnosed with mental disabilities, developmental disabilities, alcoholism or substance abuse OR in linking persons who have been diagnosed with mental disabilities, developmental disabilities, alcoholism or substance abuse to a broad range of services essential to successfully living in a community setting.
Bilingual skills (English/Spanish) preferred.
Ability to communicate well with medical providers and support staff. Ability to work well with diverse populations.
Ability to handle multiple tasks and results-driven environment.
Ability to work flexible hours including some evenings and weekends.
Ability to use common office software (Word, Excel, Power Point) and basic computer and internet navigation skills required. Familiarity with ECW preferred.
Effective oral/written/interpersonal communication skills required.


$40,000 annually; excellent benefits package

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