Health Homes Care Manager

Job Title: Health Homes Care Manager
Dept: Care Management Services
Reports to: Health Homes Manager
Location: Syracuse
Salary Range:  $22.08 - $25.04 hourly

Join our team and help people get the care and support they need.

Position Summary: Every participant's path to better health looks different, and you will help them find theirs. At ACR Health, our Health Homes Care Managers are trusted allies for Health Home participants and their families, helping them find their way through the healthcare system and knocking down the barriers in their path. You will facilitate referrals, conduct assessments, develop service plans, and coordinate services, all consistent with New York State Health Home regulations. Every day, you will team up with participants, healthcare providers, community agencies, and support systems to improve health outcomes and open doors to the services people need. It's challenging, it's rewarding, and it's a role where you can grow.

Authority and Independence: We hire smart, capable people and trust them to run with it. You will work under the general supervision of the Health Homes Manager, with the freedom to use your own independent judgment in participant engagement, assessment, care planning, service coordination, advocacy, and resource development. You'll build strong relationships with service providers and community partners, keep confidentiality rock solid, and make sure everything stays in compliance with all Health Home, Medicaid, and regulatory requirements.

Minimum Qualifications

Education and Experience

• Bachelor's degree and a minimum of two (2) years of experience in health, human services, or a related field working with individuals living with HIV/AIDS, Hepatitis C (HCV), substance use diagnoses, chronic illnesses, or related populations.


• Experience providing care coordination, case management, advocacy, or related support services.


• Experience working with diverse populations and individuals facing medical, behavioral health, housing, legal, social, or financial barriers is preferred.

Skills and Competencies

• A knack for building an inclusive, collaborative team culture where everyone feels they belong.


• A communicator and organizer extraordinaire with excellent verbal, written, interpersonal, and time management skills.


• A natural connector who loves building relationships with healthcare providers, hospitals, community agencies, participants, caregivers, and other stakeholders.


• Someone who thrives working with people from all walks of life.


• Comfortable with Microsoft Office programs, including Outlook, Word, and Excel.


• A genuine commitment to the mission, vision, and values of ACR Health.


• A big heart and real sensitivity toward HIV/AIDS, chronic illness, LGBTQ+ issues, harm reduction principles, and culturally responsive service delivery.

Other Requirements

• Valid New York State driver's license, satisfactory driving record, and access to a reliable vehicle with current automobile insurance to fulfill travel requirements throughout the service region.


• Ability to pass a Medicaid fraud background check.


• Ability to work occasional evenings and weekends for meetings, training, conferences, seminars, and participant needs.

Primary Responsibilities

• Be a guardian of trust by weaving confidentiality best practices into everything you do, in accordance with Article 27-F, HIPAA, ACR Health policies and procedures, and all applicable regulations.


• Get to know participants and their immediate and long-term needs, then connect them with the services and support that will make a real difference.


• Create, carry out, and monitor individualized care plans, working hand in hand with participants and service providers.


• Become the connector who opens doors to medical, behavioral health, legal, housing, financial, social service, and other community-based resources.


• Conduct assessments, reassessments, goal planning, and service planning in accordance with Health Home requirements, and cheer participants on as they work toward their goals.


• Keep in touch with participants through regular contact that supports engagement, motivation, service utilization, and continuity of care.


• Get out of the office and meet participants where they are with home visits and community-based visits, as appropriate, to assess needs and support service engagement.


• Team up with hospitals, healthcare providers, discharge planners, behavioral health providers, and community agencies to keep care running smoothly.


• Rally the whole team by leading interdisciplinary case conferences and collaborating with participant support networks when appropriate.


• Be a fearless voice for participants by advocating for appropriate services, working to break down barriers to care, and documenting service gaps.


• Keep complete, accurate, and timely participant records, assessments, care plans, progress notes, statistical reports, and other required documentation.


• Stay on top of your paperwork by preparing and submitting all required reports and documentation within established timeframes.


• Become a local resource expert with working knowledge of area resources, Health Home regulations, Medicaid requirements, care management standards, and community services.


• Keep growing! Participate in all required staff, department, and agency training courses and complete a minimum of twenty-four (24) hours of professional development annually.


• Stay calm and steady when it counts by providing crisis intervention and support when appropriate.


• Be a culturally competent teammate in your department and across the agency, showing respect for the beliefs, values, and needs of diverse populations.


• Pitch in on other duties as assigned by the Health Homes Manager, Director of Care Management Services, Chief Program Officer, and/or Chief Executive Officer.

Benefits: We Take Care of the People Who Take Care of Others

• Comprehensive medical, dental, and vision coverage to keep you healthy and smiling.


• Generous paid time off and holiday pay, so you can rest, recharge, and enjoy life outside of work.


• Life insurance for added peace of mind.


• 403(b) retirement savings plan with agency contributions, because your future matters too.


• Employee Assistance Program (EAP), with support for you when you need it.

FLSA Status: Exempt. Office  Hours per week:  35   Work Schedule:  Full Time in Office, occasional evenings and weekends may be required for meetings, workshops, outreach, and events.

Disclaimer: This job description provides an overview of primary duties and responsibilities. It is not exhaustive; additional consistent tasks may be assigned.

Salary/Compensation: $22.08 - $25.04 per hour