Health Home Plus (SMI) and Children's Health Home Care Coordinator - Long Island Health Home

Job DetailsJob Location: 175 Remsen Street 5th Floor, Brooklyn, NY, 11201 - Brooklyn, NY 11201Position Type: Full TimeEducation Level: High School Diploma or Educational EquivSalary Range: $30.00 - $30.00 HourlyTravel Percentage: up to 75%Join Our Team as a Health Home Plus (SMI) and Children’s Health Home Care Coordinator!   Are you passionate about supporting the Behavioral Health and Children's population and making a real difference in their lives? EAC Network, a leading not-for-profit social service agency dedicated to helping over 80,000 people through 100 impactful programs across Long Island and NYC, is looking for a dedicated full time Health Home Plus (SMI) and Children’s Health Home Care Coordinator to join the Long Island Health Home Program.   Wage: $30/ hour Schedule: 9AM-5PM, Monday- Friday Location: 175 Fulton Ave 4th Floor, Hempstead, NY, 11550 (travel between Nassau and Suffolk County)    What drives the core purpose of this job: The Health Home Plus (SMI) Care Coordinator conducts outreach, assessment and service planning to coordinate care for participants with severe mental illness (SMI) who may also have substance use disorders and/or chronic medical conditions. The Care Coordinator also does the same for children with severe medical, mental health and/or substance use diagnoses.  Works closely with clients to implement goals identified during the intake, assessment, reassessment, and care plan process. Maintains contact with the client's extended family and support networks for coordination of care.  Monitors client's progress in utilizing services to achieve better health care outcomes while containing costs. Field work required to maintain required contacts per month.   What are the key responsibilities: Maintain a caseload of regular Health Home clients, children’s Health Home clients, and/or Health Home Plus (SMI) clients. Complete the required billable contacts per month for each client. Conduct home visits and community work in the field including visiting hospitals and emergency rooms. Gather information for and/or conduct outreach, intake, assessment, re-assessments and care plans. Provide care management to a caseload through the coordination of medical, mental health and substance use services. Implement activities to facilitate participant engagement. Participate in case conferences with health home team including Case Managers and treatment providers. Ensure entitlements, insurance, and benefits are in place. Develop service plans and resolve barriers to effective service utilization. Responsible for assisting Health Home team members in implementing individualized care plans. Complete CANS training and pass CANS certification with a 70% annually. Monitor client's progress in utilizing services (appointments, treatment, medication, etc.) through telephonic and direct contact. Check that clients receive test results and track that clients follow up with medical directions. Transport and escort clients to/from appointments when needed. Collaborate on care issues with internal clinicians and the participant's assigned Health Home medical provider. Document service information in databases and use electronic systems to track participant activities.  Assist in crisis intervention and provide or refer to crisis services. Ensure that clients follow up with aftercare discharge (i.e. fill prescriptions, make appointments). Perform all other relevant duties as determined by Supervision and EAC NETWORK Administration.    What key knowledge, skills, and abilities are required to excel in this role: Master’s Degree in social work or related field plus one year of experience or Bachelor’s Degree in social work or related field plus two years of experience. CASAC or High School Diploma or educational equivalent and significant combination of education and experience in criminal justice or working with substance using and/or mentally ill population considered. Experience providing medical, mental health or substance use focused care coordination services to individuals with Serious Mental Illness, developmental disabilities, substance use disorders, or linking those individuals to services required.  Experience working with children preferred. Experience in criminal justice preferred.  Knowledge of health care environments, clinical terminology and health information systems strongly preferred. Must have valid NYS (New York State) Driver’s License and be willing to transport clients to appointments using own vehicle. Must provide proof of valid NYS car insurance and Defensive Driving Certificate within 30 days of hire. Valid registration, inspection and Automobile Insurance Liability of a recommended minimum of 100,000/300,000 will also be evaluated upon hire. Excellent organizational and time management skills, interpersonal skills, verbal and written communication skills required.  Must be proficient in computer applications or other automated systems such as spreadsheets, Microsoft Office applications, calendar, email and/or database software necessary to perform work assignments.   What We Offer: At EAC Network, you will find more than just a job – you will find a supportive work environment committed to your well-being and growth. We champion equity, justice, and belonging, fostering a workplace where every voice is valued and empowered. We offer many roles with flexible and hybrid schedules to help you maintain a healthy work-life balance, and our generous PTO policy and Summer Fridays ensure you have time to recharge. Our commitment to wellness also earned us the Gold Healthy Workforce Designation from Cigna in 2024 and 2025. Additionally, all employees are eligible to participate in EAC Network’s 401(k) plan, and full-time employees receive a 3% employer contribution after one year of service. EAC employees may also be eligible for the Public Service Loan Forgiveness program. At EAC Network, you are part of a team making a difference in our communities across Long Island and New York City, every day.