Care Manager

Make a meaningful difference where it matters most. At Elm & Oak Health, we're committed to supporting vulnerable communities through compassionate, person-centered care. We are currently seeking a Care Manager to join our team in the Chemung County area, with a dedicated focus on individuals experiencing homelessness. In this role, you'll go beyond traditional case management - working hands-on to coordinate care, advocate for essential services, and help restore stability and dignity to those most at risk. If you're driven by purpose and ready to be part of a collaborative, mission-led team, we invite you to explore this impactful opportunity. For over 50 years, Elm & Oak Health, a not-for-profit health care services organization, has been focused on improving the health status of individuals and families who are recipients of government sponsored health insurance. Elm & Oak Health is the largest Care Management Agencies serving 28 counties and over 3000 members with an outstanding reputation for excellence throughout our service area! We’ve earned that reputation by providing quality care management focused on compassion, empowerment, and teamwork. Our award-winning work culture is built on these same principles! When you join our team, you can expect to reap the intrinsic rewards of serving others while enjoying flexible work arrangements, competitive pay, superior benefits, and a supportive, inclusive culture! Candidate must be willing to travel throughout Chemung County on a regular basis. Grade 207: This is a full time position, working from home, but requires frequent travel throughout Chemung County. The minimum and maximum annual salary that Elm & Oak Health believes in good faith to be accurate for this position at the time of this posting are $46,948 - $57,380. In addition to your salary, Elm & Oak Health offers a comprehensive benefits package (all benefits are subject to eligibility requirements) and non-monetary perks. The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. POSITION SUMMARY The Care Manager’s role will involve community outreach on the streets, coordinating members’ needs before and after their move from street to home, enhancing their daily living skills, accompaniment to appointments, and advocating on their behalf when faced with discrimination or healthcare inequities. Member choice, harm reduction, non-coercion, flexibility, and person-centered care are essential elements of the SOS program model and should be front and center of the care delivered by the Care Manager. This position works with substantial independence in the field, with consultation available from Team Lead, as needed. ESSENTIAL JOB DUTIES/FUNCTIONS % of Time Essential Function 50% Outreach and Engagement - Persistent and assertive outreach and engagement using strength-based approaches beginning either at known “hang-outs” or “hot spots” within the local communities or during an inpatient hospital admission or emergency department visit. - Continuously assess the health and social needs of participants through SOS’s conversational and observational assessments and formalized risk assessment tools for those identified as being at high risk. - Participate in hospital discharge planning meetings to identify the best community resources for returning members. - Assist with appointment navigation including accompaniment to appointments, transportation training, re-engagement in community care, and addressing barriers to care. - Review documentation and conduct comprehensive psychosocial assessments to determine the medical, psychiatric, housing, and other social needs of the member within the community. - Obtain historical and collateral information from multiple sources to support members behavioral and physical health needs. - Monitor, evaluate, and record participants progress with respect to care plan goals. - Adheres to Elm & Oak Health professional boundaries and protocols. 30% Member/Provider Collaboration - Work in collaboration with the regional partners to identify available housing and to support participants through the process. - Tasks may include applying for housing, prepping for interviews, follow up with housing providers, and assistance with moving in (day of move) and with obtaining housing supplies and learning about the neighborhood. - Participate in hospital discharge planning meetings to identify the best community resources for returning members. - Once housed, work with members and their housing providers to resolve clinical issues