Care Coordinator (2)   
Family Health Center at North General-HIV Department      
 
Requirements:        Bachelor’s Degree in Social Work, preferred.  Bachelor’s in Psychology, Human Services or Sociology with experience acceptable.  Basic knowledge of computers, data entry experience a plus.  Ability to write reports and correspondence knowledge of Social Services agencies and resources in the NYC area required.  Ability to work independently and as part of a team; Bi-lingual, Spanish preferred.
 
Responsibilities:       Work as part of an interdisciplinary team to assist patients in medication adherence and self management and to track patients at risk of or lost to follow up.  Ensure clients are retained in continuous care and adhere to medical appointments and medications.  Identify patients who miss appointments for on or off-site services, call and send reminders before scheduled appointments, and address potential barriers to care. Prepare case management assessments, patient histories, service plan and reports.  Engage patients’ families or other collaterals to help keep patients in care.  Address medication adherence and provide patient support.   Provide case management services to assist patients in receiving necessary resources and services such as  Medicaid, Child Health Plus, Welfare, DAS, Social Security, Child Care, Home Care, Housing/Shelter/Safe Homes, Substance Abuse Treatment, Mental Health Treatment, HIV Services, Legal, etc.   Track referrals for services via Electronic Health Records and follow up to determine if patient kept appointment and request consult report.  Work in close collaboration with Behaviorists and other health care personnel in patient evaluation and treatment to further their understanding significant social and environmental factors underlying patient’s health problems.  Work with providers to assess child abuse and neglect and follow guidelines for reporting when necessary; provide follow-up support services to families to maximize family functioning. Participate in COMPASS team meetings, departmental meetings, case conferences and other relevant meetings, as appropriate.  Perform a complete registration of patient clinical, financial and demographic information into the Epic system.  Reconcile all charges into the 
system to the original source document.  Verify insurance coverage.  Case Manager        
Family Health Center at North General
 
Requirements:        Bachelor's degree in Social Work or related field.  Minimum of (1) one year of case management experience, preferably in a medical setting.    Bilingual Spanish preferred.  Knowledge of Medicaid and Managed Care.  Strong verbal and written communication skills required.  Proficient with computer software, data entry experience a plus.  Understanding of the healthcare environment in New York a plus.  Knowledge of Social Services agencies and resources in the NYC area.

Responsibilities:     Work as part of interdisciplinary team to help patients and families with personal and environmental difficulties, which predispose illness, of interfere with obtaining maximum benefits from medical care.  Provide case management services to assist patients in receiving necessary resources and services.  Medicaid, Child Health Plus, welfare, DAS, Social Security, Child Care, Home Care, Housing/Shelter/Safe Homes, Substance Abuse Treatment, mental Health Treatment, HIV Services Legal, etc. Work with providers to assess child abuse and neglect and follow guidelines for reporting when necessary; provide follow-up support services to families to maximize family functioning. 
Certified Diabetes Educator
Bronx Region
 
Requirements:        Registered Nurse or Registered Dietician interested in becoming a CDE are welcome to apply.  Certification in diabetes education preferred.  Minimum of three (3) years of clinical experience in this role, preferably with diverse population of patients.  Must be able to work independently and must have good communication, listening, motivation, education, problem-solving and counseling skills.  Bilingual in Spanish/English preferred.
 
Responsibilities:      Provide quality, comprehensive care for diabetic patients through individual consults and classes.  Collaborate with other team members in planning and delivering appropriate patient care.  Serve as a resource for physicians and other personnel in the care of diabetic patients.  Motivate and educate individuals with a wide range of abilities and backgrounds and vary instruction based on patient ability and motivation.    Certified Diabetes Educator
Manhattan  Region
 
Requirements:        Registered Nurse or Registered Dietician interested in becoming a CDE are welcome to apply.  Certification in diabetes education preferred.  Minimum of three (3) years of clinical experience in this role, preferably with diverse population of patients.  Must be able to work independently and must have good communication, listening, motivation, education, problem-solving and counseling skills.  Bilingual in Spanish/English preferred.
 
Responsibilities:      Provide quality, comprehensive care for diabetic patients through individual consults and classes.  Collaborate with other team members in planning and delivering appropriate patient care.  Serve as a resource for physicians and other personnel in the care of diabetic patients.  Motivate and educate individuals with a wide range of abilities and backgrounds and vary instruction based on patient ability and motivation.  
  Diabetes Care Manager (2)
Bronx Region        
 
Requirements:        Degree in Social Work, Counseling, Public Health, Human Services or Psychology required.  Ability to write reports and correspondence and must be computer proficient.  Knowledge of Social Services agencies and resources in the NYC area required.  Healthcare experience required with knowledge of chronic illness management preferred.  Ability to work independently and as part of a team.  Bi-lingual, Spanish preferred.
 
Responsibilities:       Work in close collaboration with physicians, certified diabetic educators and other health care personnel in patient evaluations and treatment to further their understanding of significant social and environmental factors underlying patient’s diabetes and other chronic health problems.            Prepare risk assessments identifying barriers to care and treatment of diabetes.  Provide care management services to assist patients in receiving necessary resources and services.  Medicaid, Child Health Plus, Welfare, DAS, Social Security, Child Care, Home Care, Housing/Shelter/Safe Homes, Substance Abuse Treatment, Mental Health Treatment, HIV and mental health services.  Work with providers to assess child abuse and neglect and follow guidelines for reporting when necessary; provide follow-up support services to families to maximize family functioning.  Document all patient services in patient’s electronic medical record in given timeframe.     Diabetes Care Manager (2)
Manhattan Region        
 
Requirements:        Degree in Social Work, Counseling, Public Health, Human Services or Psychology required.  Ability to write reports and correspondence and must be computer proficient.  Knowledge of Social Services agencies and resources in the NYC area required.  Healthcare experience required with knowledge of chronic illness management preferred.  Ability to work independently and as part of a team.  Bi-lingual, Spanish preferred.
 
Responsibilities:       Work in close collaboration with physicians, certified diabetic educators and other health care personnel in patient evaluations and treatment to further their understanding of significant social and environmental factors underlying patient’s diabetes and other chronic health problems.            Prepare risk assessments identifying barriers to care and treatment of diabetes.  Provide care management services to assist patients in receiving necessary resources and services.  Medicaid, Child Health Plus, Welfare, DAS, Social Security, Child Care, Home Care, Housing/Shelter/Safe Homes, Substance Abuse Treatment, Mental Health Treatment, HIV and mental health services.  Work with providers to assess child abuse and neglect and follow guidelines for reporting when necessary; provide follow-up support services to families to maximize family functioning.  Document all patient services in patient’s electronic medical record in given timeframe.   

Diabetes Program Coordinator
Downstate Region
 
Requirements:          Bachelor’s degree required.  At least three (3) years of experience in management/leadership/program development or coordination role.  Ability to work independently and as part of a team.  Excellent communications skills; organized, outstanding and time management and management of program timeline/deadlines required.    Proficient in Word and Excel and ability to learn new programs, such as Electronic Medical Record system required.  Bilingual, Spanish preferred.
 
Responsibilities:     Work as part of and supervise an interdisciplinary team to help patients and families with the management of diabetes.  Supervise the work of 4 diabetic educators and four case managers to assist in identifying and helping patients overcome risks and barriers which predispose to illness, or which interfere with obtaining maximum benefits from medical care with an ultimate goel of improving adherence supporting self-management skills, and achieving unparalleled health outcomes.  

HIV Tester
Family Health Center at North General
 
Requirements:          High School Diploma required, Bachelor’s in Psychology, Human Services or Sociology with experience preferred.  Basic knowledge of computers, data entry experience a plus.  Knowledge of HIV and HIV testing preferred.  Ability to write reports and correspondence; knowledge of Social Services agencies and resources in the NYC area.  Healthcare experience preferred.  Ability to work independently and as part of a team required.  Bi-lingual, Spanish preferred.
 
Responsibilities:     Help patients and community members have access to rapid HIV testing. Conduct rapid HIV testing for individuals in Institute Health Centers and programs and community events. Provide education to patients and community members on HIV testing and HIV in general.  Work with providers to assess child abuse and neglect and follow guidelines for reporting when necessary; provide follow-up support services to families to maximize family functioning.  Develop linkages with community agencies as needed to encourage testing referrals.  Provide monthly statistical reports to administration. Identify service gaps and seeks solutions.  Appropriately advocate for patients with outside systems.  Document all outreach attempts to patients and collaboration with health care team.  Accurately record level of service in electronic medical record system; respond to all referral requests within 48 hours.  Complete psychosocial assessment on all new patients on first visit.
Patient Navigator (3)             
Family Health Center at North General-HIV Department 
 
Requirements: High school diploma required, Bachelor’s degree in Social Work, preferred. Bachelor’s in Psychology, Human Services or Sociology with experience acceptable. Knowledge of HIV programs and services in the New York City area required.  The ability to write professional reports and correspondence required.  Knowledge of health care and health care applications .  Ability to identify resources and utilize problem solving skills in order to meet patient’s individual needs.  Basic knowledge of computers, data entry experience a plus.  Bi-lingual, Spanish preferred but not required. 
                                           
Responsibilities:       Accompany patients to medical appointments; provide psychosocial support and psychoeducation; maintain patient’s access to entitlement benefits. Conduct home visits when necessary, provide case management to address patient’s individual needs as they pertain to treatment adherence, including but limited to transportation to medical appointments and childcare.  Work with providers to assess child abuse and neglect and follow guidelines for reporting when necessary; provide follow-up support services to families to maximize family functioning. 
 

Program Director          
River Center

Requirements:        MSW, LCSW, PhD or PsyD.  Able to provide advanced clinical supervision to interns and staff required.  Experience working with diverse populations i.e HIV, homeless, mentally ill, elderly, children, Adolescents, etc. required.  Technical knowledge of program development and relevant community resources, ability to develop linkage with community organizations, as well as excellent communication and human relation skills. 
 
Responsibilities:       Assist, develop and participate in quality assurance activities and promote high quality, comprehensive, effective patient care.  Prepare monthly statistical reports, monitors program dashboard and other performance indicators.  Participates in and helps in the coordination of staff development programs and in-service trainings.  Assist in facilitation of monthly psychosocial services meetings.  Prepare monthly statistical reports, monitors program dashboard and other performance indicators.  Participate and attends community meetings/conferences, conducts trainings. Facilitate ongoing chart reviews to ensure quality indicators are met. Co-sign student progress notes and evaluations. Assure Social Services compliance with legal, regulatory and professional standards including article 28, article 31, article 32, JCAHO, OMH and OASAS.

    
Social Worker 
Family Health Center at North General

Requirements:        Master's degree in Social Work or related field.  Bilingual Spanish preferred.  LCSW needed. Experience working with homeless population, mental health and substance abuse.  Excellent clinical and case management skills required. 

Responsibilities:       Provide direct social work services, which include crisis intervention, individual, family and group counseling in collaboration with other members of an interdisciplinary team and completion of relevant documents, psychosocial evaluations or service planed case management services.  Work in collaboration with physicians and other health care personnel in patient evaluation and treatment, to further their understanding of significant social and emotional factors underlying patient’s health problems. Demonstrates the knowledge and skills necessary to provide care, based on physical, psychosocial, educational, safety, and related criteria, appropriate to the age of the patients served in assigned area.

Social Worker (Part-Time)
Family Health Center at North General

Requirements:        Master's degree in Social Work or related field.  Bilingual Spanish preferred.  LCSW needed. Experience working with homeless population, mental health and substance abuse.  Excellent clinical and case management skills required. 

Responsibilities:       Provide direct social work services, which include crisis intervention, individual, family and group counseling in collaboration with other members of an interdisciplinary team and completion of relevant documents, psychosocial evaluations or service planed case management services.  Work in collaboration with physicians and other health care personnel in patient evaluation and treatment, to further their understanding of significant social and emotional factors underlying patient’s health problems. Demonstrates the knowledge and skills necessary to provide care, based on physical, psychosocial, educational, safety, and related criteria, appropriate to the age of the patients served in assigned area.