Catholic Charities of Onondaga County

Care Manager - Health Services Coordination

2 months ago
# of Openings


Catholic Charities of Onondaga County is a human services agency, dedicated to caring for those in need while promoting human development, collaboration, and the elimination of poverty and injustice.  Catholic Charities believes that all people have infinite value and are worthy of dignity and respect, and above all, is committed to creating hope and transforming lives.


This is a Full Time position; 35 hours per week, Monday-Friday.


Provide comprehensive care management, care coordination, comprehensive transitional care, patient & family support & health promotion. Referrals to community & social support services.

  1. Provide comprehensive assessment and reassessment of clients as needed inclusive of medical, behavioral, rehabilitation, social service and long term care needs.
  2. Identify eligible clients by working with case workers in the agency and community. Educate providers on eligibility criteria and work with lead health home to determine eligibility.
  3. Complete and/or revise as needed patient centered plan of care.
  4. Prepare client crisis intervention plan and participate in its execution as needed.
  5. Ensure the delivery of all aspects of care coordination including work with service providers and health plans to provide necessary care for clients.
  6. Advocate for services and assist with scheduling of medical services, monitor and support attendance at these services.
  7. Ensure the provisions of comprehensive transitional care including follow up with hospitals, ER, residential rehabilitation, following admissions and discharges to outpatient providers.
  8. Provide patient and family support by including family members in client’s plan of care when appropriate and serving as a resource to client and family regarding patient and community programs.
  9. Refer clients and family members as needed to appropriate community supporters and help connect to those services.
  10. Complete all required documentation in timely and through manner.
  11. Maintain guidelines established by the funding sources and Catholic Charities policies and procedures.



Bachelor’s degree in Nursing of Human Services related field and a minimum of three (3) years experience working in care coordination or an equivalent combination of education and experience. Demonstrated ability to work with people of diverse backgrounds. Thorough working knowledge of local and regional public and private resources, including Social Security, Department of Social Service Adult Protective Unit, Income Assistance Unit and various other agencies and offices as needed.


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