Description
Housing Works requires employees working in our Health Services division to be fully vaccinated against COVID-19, unless approved for a legal accommodation. If you need an accommodation for any reason, including related to this job requirement, please contact Human Resources.
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Housing Works was founded in 1990; With a long-term commitment to AIDS advocacy. Housing Works established New York State's first harm reduction-based, OASAS-licensed outpatient drug treatment program. Other services include Health Home care management, behavioral health, and syringe exchange programs. A pioneer in the social entrepreneurship movement, Housing Works operates 10 high-end thrift shops in Manhattan and Brooklyn and a much-loved Bookstore Cafe in Soho. For more information, visit
Housing Works fights for funding and legislation to ensure that all people living with HIV/AIDS have access to quality housing, healthcare, HIV prevention, and treatment, among other lifesaving services.
Benefits:
We have three comprehensive healthcare plans to choose from based on your priorities and budget. Housing Works covers most of the plan; you pay a portion, based on your salary. Staff begins accruing PTO immediately for a total of up to 30 days earned in the first year. We offer employees an educational benefit. This money is available for tuition loan reimbursement, tuition costs, and text books.
Housing Works provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements. Housing Works complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. Housing Works also does not request prior salary information during the hiring process. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.
This position is included in a bargaining unit of Housing Works' New York City employees represented by a labor union known as the Retail Wholesale and Department Store Union ("RWDSU"). Accordingly, the RWDSU has the exclusive right to bargain over the terms and conditions of employment related to this position and this position may become covered by the terms of a collective bargaining agreement (a "CBA") between Housing Works and the RWDSU
Compensation Range: $20/hr - $23/hr commensurate with experience
Overview:
Patient Care Coordinator (PCC) is responsible for screening patients' social determinants of health and helping determine best ways to ensure they are met by referring to other programs and services as needed. The PCC advocates for patients' best interests and helps ensure that the services outlined in their clinical pathway plan are provided.
Responsibilities:

1. Coordinates with Intake Specialist to ensure that PRAPARE assessment for new and annual patient visits are completed. Provide coverage for Patient PRAPARE.
2. Along with the Intake Specialist, conduct PRAPARE assessment for all clients enrolled in primary care and behavioral health, and facilitate overall coordination of care as well as provide case management referrals.
3. Coordinate with other care management teams both internally and externally, to help patient meet their care plan goals.
4. Facilitate communication with OASAS, Health Home, ADHC, Youth and Prevention Services, RAD and other clinical and support staff on issues related to clients' progress, referrals, and outreach needs.
5. Facilitate enrollment of patients in the Undetectables (UND) program.
6. Facilitate medical records requests and ensure completion within timeline outlined in policies including required fields.
7. Ensure UND patients remain in good standing (eg renewals, up to date labs, etc).
8. Participate in interdisciplinary meetings and transcribe meeting minutes for quality improvement projects as needed.
9. Oversee or directly facilitate documentation of hospitalizations and discharge follow-up appointments as needed.
10. Set up regular on-site meetings with case managers to review status of dually enrolled clients.
11. Document significant issues discussed regarding client progress.
12. Participate in daily Huddle, regular staff meetings including but not limited to Quality Improvement, etc.
13. Collaborate with Nurse Care Coordinator to create huddle sheets relating to patient needs for provider follow-up.
14. Document clinical and administrative interventions in the medical records.
15. Support and participate in advocacy efforts.
16. Assist providers with paperwork needed by clients regarding various needs (i.e. Transportation, Home Health Aide, M11Q, HASA, Utilization Threshold, Restriction, Letters, Verifications, etc).
17. Process paperwork as requested and ensure proper documentation within the medical record.
18. Monitor patients without case management for Undetectable project, including case conferences and coordination of care.
19. Work with programs on scheduling case conference meetings with providers, and do same for clients who do not belong to internal case management program.
20. Conduct or oversee patient outreach especially for those who have been lost to follow and must be reengaged.
21. Understand the needs of customers, effectively provide service and or resolve problems, and escalate to Clinic Director as needed.
22. Ensure dedication to meeting the expectations of internal and external customers, working to create a positive experience for all.
23. Understanding and Practice of the Housing Works Core values of Membership, All In, Stronger Together, Membership and High Performance.
24. Understanding while working in a fast pace environment with competing priorities may require assisting in other roles as needed.
25. Other duties as assigned.

• Associate's Degree, or higher, required.
• One to two years of previous experience in a medical setting or related field preferred.
• The candidate must have a strong knowledge in HIV/AIDS, case management and entitlements.
• The candidate should be able to perform PRAPARE assessments and demonstrate the ability to discern emergencies and alert the appropriate personnel for assistance and support.
• Must have experienced with Microsoft Office (Word, Excel), Outlook, and the Internet.
• Knowledge of electronic medical record systems is required.
• Commitment to confidentiality and HIPAA regulations on requests for medical documents is required.
• Strong organizational and clinical skills required.
• Proficiency in Spanish.
• Candidate must be willing to work weekends and evenings, with advance notice.
• Must be willing to participate in advocacy events.