Join Our Team

Job Title: Social Care Network Housing Performance Manager

Reports to: SCN Project Director

Organizational Overview:

Forward Leading IPA (FLIPA) is a nonprofit membership association of safety net providers working in partnership to provide the highest quality integrated healthcare to historically underserved populations in Upstate New York since 2017. FLIPA is renowned for its commitment to integrating primary care, behavioral health, and social care needs. Our growing membership serves individuals across Upstate NY and includes federally qualified health centers (FQHCs), behavioral health providers, and a rural health network consisting of eight county public health departments.

Job Summary:

The Social Care Network Housing Performance Manager is responsible for designing, implementing, and overseeing all housing‑related service domains under the NYS 1115 Social Care Demonstration Waiver within the Social Care Network (SCN) Lead Entity, including Rent and Temporary Housing, Home Modifications, Tenancy Sustaining and Transition services, etc. This role ensures high-quality delivery of housing services across the network by supporting FLIPA’s contracted network of Housing Service Providers. The Housing Performance Manager will work to strengthen operational workflows, ensure compliance with waiver standards, and partner closely with the Training Lead to build and deliver training that optimizes performance, outcomes, and ensures a strong Medicaid member experience. This position is funded through March 2027

Equal Employment Opportunity Statement: At Forward Leading IPA (FLIPA), we value individuals’ unique backgrounds, experiences, and perspectives. We are committed to fostering an environment where all qualified applicants are encouraged to apply and will receive equal consideration for employment. We do not discriminate based on race, color, religion, age, sex, gender identity or expression, national origin, disability status, veteran status, or any other characteristic protected by federal, state, or local laws.

We believe that building a strong team starts with hiring individuals whose skills and perspectives reflect the communities we serve. We actively promote opportunity for all and strive to ensure that each team member’s talents and potential are recognized and valued. Our hiring decisions are based solely on individual merit.

FLIPA is committed to prioritizing the human element in healthcare. By encouraging different viewpoints and fostering innovative thinking, we aim to build empowered, healthy, and thriving communities. Join us in making a meaningful impact.

Security Level: Standard - SCN

Duties/Responsibilities:

Housing Program Leadership & Strategy

• Serve as the subject‑matter expert on all housing services under the NYS 1115 Social Care Demonstration Waiver.
• Operationalize housing-related program requirements, workflows, performance standards, and documentation expectations.
• Ensure Housing Service alignment with NYS DOH, CMS, and Lead Entity housing policies and requirements.
• Monitor policy updates and translate them into actionable procedures.

Support to Contracted Housing Providers

• Provide technical assistance, coaching, and troubleshooting to external Housing Service Providers
• Support onboarding and operational readiness of Housing Service Providers.
• Conduct provider touchpoints and offer problem‑solving support.
• Participate in quality assurance and continuous improvement.

Training, Curriculum, and Capacity‑Building

• Partner with the Training Lead to co‑design housing‑related curriculum and job aids.

• Deliver training to contracted partners and internal staff.
• Identify gaps and guide targeted training to enhance quality and capacity.

Performance Monitoring & Data Use

• Review operational, encounter, quality, and outcome data.

• Collaborate with analytics teams to evaluate housing services performance

• Support corrective action planning when performance issues arise

Cross-Functional Collaboration

• Coordinate with Care Navigation, Network Management, Compliance, IT, and Quality teams
• Support complex housing cases requiring higher‑level coordination

Other duties as assigned

• Perform additional related responsibilities as needed to support the goals of the Social Care Network initiative.

Education & Experience:

• Bachelor's degree in relevant field, or equivalent experience required

• 2+ years direct care service delivery with Medicaid or similar populations
• 5+ years housing services, supportive housing, tenancy supports, or Social Determinants of Health (SDoH) experience
• Strong knowledge of NYS housing systems and Medicaid-related housing services
• Experience providing technical assistance or program support to providers.
• Experience training or facilitating learning for adult learners
• Familiarity with HIPAA, data security and privacy, and IT compliance

Preferred Qualifications:

• Experience with NYS Medicaid or the 1115 Waiver
• Understanding of documentation, billing, and encounter standards
• Experience working in community-based housing organizations

• Highly proficient with Microsoft Office Suite, including Microsoft Teams
• Flexible, adaptable style that takes in stride last minute changes and project pivots and thrives on creative problem-solving
• Able to work quickly and efficiently

• projects and tasks independently
• Attention to detail and accuracy
• Confidentiality

Core Competencies:

• Housing Services Expertise: Deep knowledge of tenancy support, housing navigation, homelessness prevention, and housing stabilization best practices.
• Policy Interpretation & Application: Ability to translate NYS DOH/CMS guidance into operational processes.
• Provider Relationship Management: Skilled in supporting, coaching, and building strong relationships with external partners.
• Training & Facilitation: Clear, engaging communication and adult learning strategies.
• Problem Solving & Critical Thinking: Ability to navigate complex housing barriers and member needs.
• Communication Skills: Strong written and verbal communication across diverse stakeholders.
• Data‑Informed Decision-Making: Ability to interpret performance data to drive improvements.
• Cultural Humility & Member-Centered Approach: Commitment to equitable, person‑centered practices.
• Project & Workflow Management: Ability to structure, manage, and improve operational processes.

Salary:

• $80,000 annually

Additional information:

• Hybrid role with statewide travel up to 20–30%

• Occasional evening or weekend sessions depending on provider needs

Job Title: Social Care Network Nutrition Performance Manager

Reports to: SCN Project Director

Organizational Overview:

Forward Leading IPA (FLIPA) is a nonprofit membership association of safety net providers working in partnership to provide the highest quality integrated healthcare to historically underserved populations in Upstate New York since 2017. FLIPA is renowned for its commitment to integrating primary care, behavioral health, and social care needs. Our growing membership serves individuals across Upstate NY and includes federally qualified health centers (FQHCs), behavioral health providers, and a rural health network consisting of eight county public health departments.

Job Summary:

The Social Care Network Nutrition Performance Manager is responsible for designing, implementing, and overseeing all nutrition‑related service domains under the NYS 1115 Social Care Demonstration Waiver within the Social Care Network (SCN) Lead Entity, including nutrition counseling and education, medically tailored or clinically appropriate home delivered meals/food prescriptions, pantry stocking, cooking supplies, etc. This role ensures high-quality delivery of nutrition services across the network by supporting FLIPA’s contracted network of Nutrition Service Providers. The Nutrition Performance Manager will work to strengthen operational workflows, ensure compliance with waiver standards, and partner closely with the Training Lead to build and deliver training that optimizes performance, outcomes, and ensures a strong Medicaid member experience. This position is funded through March 2027

Equal Employment Opportunity Statement: At Forward Leading IPA (FLIPA), we value individuals’ unique backgrounds, experiences, and perspectives. We are committed to fostering an environment where all qualified applicants are encouraged to apply and will receive equal consideration for employment. We do not discriminate based on race, color, religion, age, sex, gender identity or expression, national origin, disability status, veteran status, or any other characteristic protected by federal, state, or local laws.

We believe that building a strong team starts with hiring individuals whose skills and perspectives reflect the communities we serve. We actively promote opportunity for all and strive to ensure that each team member’s talents and potential are recognized and valued. Our hiring decisions are based solely on individual merit.

FLIPA is committed to prioritizing the human element in healthcare. By encouraging different viewpoints and fostering innovative thinking, we aim to build empowered, healthy, and thriving communities. Join us in making a meaningful impact.

Security Level: Standard - SCN

Duties/Responsibilities:

Nutrition Program Leadership & Strategy

• Serve as the subject‑matter expert on all nutrition services under the NYS 1115 Social Care Demonstration Waiver.
• Operationalize nutrition-related program requirements, workflows, performance standards, and documentation expectations.
• Ensure nutrition service alignment with NYS DOH, CMS, and Lead Entity Nutrition policies and requirements.
• Monitor policy updates and translate them into actionable procedures.

Support to Contracted Nutrition Providers

• Provide technical assistance, coaching, and troubleshooting to external Nutrition Service Providers
• Support onboarding and operational readiness of Nutrition Service Providers.
• Conduct provider touchpoints and offer problem‑solving support.
• Participate in quality assurance and continuous improvement.

Training, Curriculum, and Capacity‑Building

• Partner with the Training Lead to co‑design nutrition‑related curriculum and job aids.

• Deliver training to contracted partners and internal staff.
• Identify gaps and guide targeted training to enhance quality and capacity.

Performance Monitoring & Data Use

• Review operational, encounter, quality, and outcome data.

• Collaborate with analytics teams to evaluate nutrition services performance

• Support corrective action planning when performance issues arise

Cross-Functional Collaboration

• Coordinate with Care Navigation, Network Management, Compliance, IT, and Quality teams
• Support complex nutrition-related cases requiring higher‑level coordination

Other duties as assigned

• Perform additional related responsibilities as needed to support the goals of the Social Care Network initiative.

Education & Experience:

• Bachelor's degree in relevant field, or equivalent experience required

• 2+ years direct care service delivery with Medicaid or similar populations
• 5+ years in nutrition services, nutrition counseling and education, or Social Determinants of Health (SDoH) experience
• Strong knowledge of NYS Nutrition programs and Medicaid-related Nutrition services
• Experience providing technical assistance or program support to providers.
• Experience training or facilitating learning for adult learners
• Familiarity with HIPAA, data security and privacy, and IT compliance

Preferred Qualifications:

• Experience with NYS Medicaid or the 1115 Waiver
• Understanding of documentation, billing, and encounter standards
• Experience working in community-based nutrition organizations

• Highly proficient with Microsoft Office Suite, including Microsoft Teams
• Flexible, adaptable style that takes in stride last minute changes and project pivots and thrives on creative problem-solving
• Able to work quickly and efficiently

• projects and tasks independently
• Attention to detail and accuracy
• Confidentiality

Core Competencies:

• Nutrition Services Expertise: Deep knowledge of nutrition assistance programs and nutrition counseling and education best practices.
• Policy Interpretation & Application: Ability to translate NYS DOH/CMS guidance into operational processes.
• Provider Relationship Management: Skilled in supporting, coaching, and building strong relationships with external partners.
• Training & Facilitation: Clear, engaging communication and adult learning strategies.
• Problem Solving & Critical Thinking: Ability to navigate complex barriers and member needs.
• Communication Skills: Strong written and verbal communication across diverse stakeholders.
• Data‑Informed Decision-Making: Ability to interpret performance data to drive improvements.
• Cultural Humility & Member-Centered Approach: Commitment to equitable, person‑centered practices.
• Project & Workflow Management: Ability to structure, manage, and improve operational processes.

Salary:

• $80,000 annually

Additional information:

• Hybrid role with statewide travel up to 20–30%
• Occasional evening or weekend sessions depending on provider needs

Job Title: Social Care Network Transportation Performance Manager

Reports to: SCN Project Director

Organizational Overview:

Forward Leading IPA (FLIPA) is a nonprofit membership association of safety net providers working in partnership to provide the highest quality integrated healthcare to historically underserved populations in Upstate New York since 2017. FLIPA is renowned for its commitment to integrating primary care, behavioral health, and social care needs. Our growing membership serves individuals across Upstate NY and includes federally qualified health centers (FQHCs), behavioral health providers, and a rural health network consisting of eight county public health departments.

Job Summary:

The Social Care Network Transportation Performance Manager is responsible for designing, implementing, and overseeing all Transportation‑related service domains under the NYS 1115 Social Care Demonstration Waiver within the Social Care Network (SCN) Lead Entity. This role ensures high-quality delivery of transportation services across the network by supporting FLIPA’s contracted network of Transportation Service Providers. The Transportation Performance Manager will work to strengthen operational workflows, ensure compliance with waiver standards, and partner closely with the Training Lead to build and deliver training that optimizes performance, outcomes, and ensures a strong Medicaid member experience. This position is funded through March 2027

Equal Employment Opportunity Statement: At Forward Leading IPA (FLIPA), we value individuals’ unique backgrounds, experiences, and perspectives. We are committed to fostering an environment where all qualified applicants are encouraged to apply and will receive equal consideration for employment. We do not discriminate based on race, color, religion, age, sex, gender identity or expression, national origin, disability status, veteran status, or any other characteristic protected by federal, state, or local laws.

We believe that building a strong team starts with hiring individuals whose skills and perspectives reflect the communities we serve. We actively promote opportunity for all and strive to ensure that each team member’s talents and potential are recognized and valued. Our hiring decisions are based solely on individual merit.

FLIPA is committed to prioritizing the human element in healthcare. By encouraging different viewpoints and fostering innovative thinking, we aim to build empowered, healthy, and thriving communities. Join us in making a meaningful impact.

Security Level: Standard - SCN

Duties/Responsibilities:

Transportation Program Leadership & Strategy

• Serve as the subject‑matter expert on all transportation services under the NYS 1115 Social Care Demonstration Waiver.
• Operationalize transportation-related program requirements, workflows, performance standards, and documentation expectations.
• Ensure transportation service alignment with NYS DOH, CMS, and Lead Entity transportation policies and requirements.
• Monitor policy updates and translate them into actionable procedures.

Support to Contracted Transportation Providers

• Provide technical assistance, coaching, and troubleshooting to external Transportation Service Providers
• Support onboarding and operational readiness of Transportation Service Providers.
• Conduct provider touchpoints and offer problem‑solving support.
• Participate in quality assurance and continuous improvement.

Training, Curriculum, and Capacity‑Building

• Partner with the Training Lead to co‑design Transportation‑related curriculum and job aids.

• Deliver training to contracted partners and internal staff.
• Identify gaps and guide targeted training to enhance quality and capacity.

Performance Monitoring & Data Use

• Review operational, encounter, quality, and outcome data.

• Collaborate with analytics teams to evaluate transportation services performance

• Support corrective action planning when performance issues arise

Cross-Functional Collaboration

• Coordinate with Care Navigation, Network Management, Compliance, IT, and Quality teams
• Support complex transportation-related cases requiring higher‑level coordination

Other duties as assigned

• Perform additional related responsibilities as needed to support the goals of the Social Care Network initiative.

Education & Experience:

• Bachelor's degree in relevant field, or equivalent experience required

• 2+ years direct care service delivery with Medicaid or similar populations
• 5+ years in Transportation services, or Social Determinants of Health (SDoH) experience
• Strong knowledge of transportation programs and Medicaid-related transportation services
• Experience providing technical assistance or program support to providers.
• Experience training or facilitating learning for adult learners
• Familiarity with HIPAA, data security and privacy, and IT compliance

Preferred Qualifications:

• Experience with NYS Medicaid or the 1115 Waiver
• Understanding of documentation, billing, and encounter standards
• Experience working in community-based transportation organizations

• Highly proficient with Microsoft Office Suite, including Microsoft Teams
• Flexible, adaptable style that takes in stride last minute changes and project pivots and thrives on creative problem-solving
• Able to work quickly and efficiently

• projects and tasks independently
• Attention to detail and accuracy
• Confidentiality

Core Competencies:

• Transportation Services Expertise: Deep knowledge of public and private transportation services and best practices in both rural and urban environments.
• Policy Interpretation & Application: Ability to translate NYS DOH/CMS guidance into operational processes.
• Provider Relationship Management: Skilled in supporting, coaching, and building strong relationships with external partners.
• Training & Facilitation: Clear, engaging communication and adult learning strategies.
• Problem Solving & Critical Thinking: Ability to navigate complex barriers and member needs.
• Communication Skills: Strong written and verbal communication across diverse stakeholders.
• Data‑Informed Decision-Making: Ability to interpret performance data to drive improvements.
• Cultural Humility & Member-Centered Approach: Commitment to equitable, person‑centered practices.
• Project & Workflow Management: Ability to structure, manage, and improve operational processes.

Salary:

• $80,000 annually

Additional information:

• Hybrid role with statewide travel up to 20–30%

• Occasional evening or weekend sessions depending on provider needs

Job Title: Chief Medical Officer

Reports To: Chief Executive Officer

Job Summary: The Chief Medical Officer is responsible for the development and execution of effective healthcare programs and policies, focusing on preventive care, integrated care, best practices, and healthcare access. Collaboration will be a crucial aspect of your role, as you will work closely with cross-functional teams to develop innovative healthcare solutions that address the unique needs of our company.

Organizational Overview: Forward Leading IPA (FLIPA) is a nonprofit membership association of safety net providers working in partnership to provide the highest quality integrated healthcare to historically underserved populations in Upstate New York since 2017. FLIPA is renowned for its commitment to integrating primary care, behavioral health, and social care needs. Our growing membership serves individuals across more than 27 counties and includes federally qualified health centers (FQHCs), behavioral health providers, and a rural health network consisting of eight county public health departments.

Equal Employment Opportunity Statement: At Forward Leading IPA (FLIPA), we deeply value diversity in background, experience, and thought. We are committed to creating an environment of belonging where all qualified applicants are encouraged to apply and will receive equal consideration for employment. We do not discriminate based on race, color, religion, age, sex, gender identity or expression, national origin, disability status, veteran status, or any other characteristic protected by federal, state, or local laws.

We believe that fostering spaces of belonging and advancing health equity begins with a workforce that reflects the diverse communities we serve. We actively promote equity of opportunity and strive to ensure that each team member’s unique skills, talents, and potential are recognized and valued. We are dedicated to supporting and welcoming a wide range of candidates, making hiring decisions based solely on individual merit.

FLIPA is committed to prioritizing the human element in healthcare. By embracing diverse perspectives and fostering innovative thinking, we aim to build empowered, healthy, and thriving communities. Join us on this journey and contribute to a mission that makes a meaningful impact.

Security Level: Leadership

Duties/ Responsibilities:

• Operational Leadership:
• Collaborate with the executive team to develop and implement policies, procedures, and programs that promote quality improvement and operational efficiency.
• Support relationships/agreements with external partners, contractors, and vendors.
• Develop and execute the organization’s clinical vision, strategies and objectives, aligning them with its goals and mission.
• Supervise staff engaged in VBP and Performance Management activities.
• Strategic Planning:
• Collaborate with the CEO and executive team to develop and implement long-term strategies for growth and sustainability.
• Stay updated on emerging trends, research, and best practices in healthcare to ensure that the organization remains at the forefront of medical advancements.
• Performance Management:
• Monitor performance metrics and operational efficiency in value-based payment arrangements, making adjustments as necessary to achieve optimal results.
• Regularly evaluate the efficiency of business procedures according to organizational objectives and apply improvements.
• Establish relationships with FLIPA Member providers to advance VBP and associated programs and to incorporate FLIPA member needs in the strategy.
• Design, collaborate and participate in Performance Management Committee and related cohorts and meetings.
• Financial Oversight:
• Participate in budget review, financial planning, and resource allocation to ensure financial health and sustainability.
• Compliance and Quality Assurance:
• Collaborate with Compliance Officer to support policy and procedure development, implementation, and regular update and review.
• Team Development:
• Lead interdisciplinary teams, encouraging collaboration, communication, and knowledge sharing among medical professionals and staff.
• Foster a culture of continuous quality improvement, monitoring key performance indicators, and implementing initiatives to optimize healthcare delivery.

• Other duties as assigned.

Education & Experience:

• M.D. or D.O. degree from an accredited institution with active, unrestricted license to practice medicine and current Board-Certification.

• Extensive Medicare and Medicaid experience with in-depth knowledge of risk adjustment and value-based programs in addition to state and federal regulations

Skills, Knowledge, and Abilities:

• Excellent organizational and leadership abilities

• Outstanding communication and people skills
• Knowledge of industry’s legal rules and guidelines
• Working knowledge of data analysis and performance/operation metrics
• Familiarity with MS Office and various business software

Salary Range:

• Salary is commensurate to education and experience with a range of pay $170,000 - $190,000.

Job Title: Social Health Engagement Specialist

Reports to: FLIPA Community Health Worker Supervisor and Whitney Young Health Sr. Director Behavioral Health Service Lines

Social Care Network Summary: The New York State Department of Health has established Social Care Networks (SCNs) as part of the 1115 Waiver Demonstration Amendment, The SCN’s aim is to enhance the delivery of social care services to Medicaid members by coordinating efforts among community-based organizations (CBOs) and other health care partners to create a more resilient, flexible, and accessible social care system that reduces health disparities and advances health equity. The SCN will collaborate with CBOs and other health care partners, leveraging shared data and technology to coordinate social care services for Medicaid members to improve access, ensure reliable and timely referrals, streamline and track navigation and completed referrals in closed loop systems and enhance collaboration between social care service providers and other regional partners.

Job Summary: This position is responsible for establishing trusting relationships with patients while providing support in navigating and accessing resources and engaging patients in goal-driven care. The Social Health Engagement Specialist systematically identifies, assesses, refers, and monitors high-need individuals to ensure access to essential services while supporting providers and the Care Team through an integrated approach to care management and community outreach.

This position is funded through March 2027.

Organizational Overview: Forward Leading IPA (FLIPA) is a nonprofit membership association of safety net providers working in partnership to provide the highest quality integrated healthcare to historically underserved populations in Upstate New York since 2017. FLIPA is renowned for its commitment to integrating primary care, behavioral health, and social care needs. Our growing membership serves individuals across Upstate NY and includes federally qualified health centers (FQHCs), behavioral health providers, and a rural health network consisting of eight county public health departments.

Host Organization Overview:

As a Federally Qualified Health Center (FQHC), Whitney M. Young, Jr. Health Center (WYH) is a nonprofit established in 1971 to provide access to consistent, high-quality healthcare to underserved neighborhoods in the Capital District without regard to income. Their mission is to deliver equitable and accessible quality care – empowering our diverse community to achieve better health and wellness. They envision a future in which all people achieve their highest level of health and well-being. WYH offers medical (primary care), dental, behavioral health, and numerous specialty services to more than 20,000 men, women, and children annually at health centers in Albany, Troy, and Watervliet in the Capital Region of New York State. They serve a racially and ethnically diverse population that speaks more than 40 different languages.

Equal Employment Opportunity Statement: At Forward Leading IPA (FLIPA), we deeply value diversity in background, experience, and thought. We are committed to creating an environment of belonging where all qualified applicants are encouraged to apply and will receive equal consideration for employment. We do not discriminate based on race, color, religion, age, sex, gender identity or expression, national origin, disability status, veteran status, or any other characteristic protected by federal, state, or local laws.

We believe that fostering spaces of belonging and advancing health equity begins with a workforce that reflects the diverse communities we serve. We actively promote equity of opportunity and strive to ensure that each team member’s unique skills, talents, and potential are recognized and valued. We are dedicated to supporting and welcoming a wide range of candidates, making hiring decisions based solely on individual merit.

FLIPA is committed to prioritizing the human element in healthcare. By embracing diverse perspectives and fostering innovative thinking, we aim to build empowered, healthy, and thriving communities. Join us on this journey and contribute to a mission that makes a meaningful impact.

Security Level: Shared Staff - FLIPA

Duties/Responsibilities:

• Provide a vital link between local communities and healthcare providers by helping individuals access resources and navigate systems.
• Proactively outreach and engage identified individuals in need of services, follow up or social care screening by connecting via phone calls, home visits and/or in-person visits to other settings where patients can be found.
• Support deployment of NYS Social Care Network screening and referral process
• Engage directly with Medicaid individuals to administer the Health-Related Social Needs Screening Tool to identify needed areas of support.
• Facilitate referrals to appropriate community resources and healthcare providers.
• Collaborate with the Care Team to ensure timely follow-up and service linkage.
• Use designated online referral systems and databases to track and manage client referrals.
• Provide care management related to social care services
• Accurately document in electronic systems and maintain detailed and organized records in compliance with organizational policies and standards.
• Work closely with the Care Team, including care coordinators and other healthcare professionals, to align to a whole person care approach.
• Participate in regular team meetings and contribute insights on client progress.
• Attend regular supervision, staff meetings, trainings and other meetings, as requested.
• Other duties as assigned

Education & Experience:

• Minimum of Associate's degree in human services, social work or other related degree preferred.
• Equivalent experience in lieu of education may be considered.
• Minimum of 1-3 years' human services experience.

Skills, Knowledge, and Abilities:

• Possess excellent verbal and written communication skills.
• Exceptional customer service skills with commitment to helping others.
• Ability to quickly adapt and be flexible in approach to job tasks and challenges and maintain emotional control under stress.
• Excellent time management skills with exceptional attention to detail and the ability to multi-task and manage multiple priorities with competing deadlines.
• Capability to work cooperatively with culturally diverse clients, staff, and community service providers.
• Basic computer literacy, including the ability to use email, conduct online research, and create basic documents (MS Office Suite including Excel, Outlook and Word).
• NYS motor vehicle license, safe driving record and availability of personal vehicle for work.
• Holds self and others responsible and accountable to meet commitments.

Salary Range:

• Salary is commensurate to education and experience with a range of $22 to $24 per hour

Additional information:

• This position is an in-person role, embedded within Whitney Young Health - a FLIPA member organization.
• This position is located in the Albany region.

Job Title: Jordan Health Community Health Worker

Reports to: FLIPA Community Health Worker Supervisor and Jordan Health Community Health Worker

Social Care Network Summary: The New York State Department of Health has established Social Care Networks (SCNs) as part of the 1115 Waiver Demonstration Amendment, The SCN’s aim is to enhance the delivery of social care services to Medicaid members by coordinating efforts among community-based organizations (CBOs) and other health care partners to create a more resilient, flexible, and accessible social care system that reduces health disparities and advances health equity. The SCN will collaborate with CBOs and other health care partners, leveraging shared data and technology to coordinate social care services for Medicaid members to improve access, ensure reliable and timely referrals, streamline and track navigation and completed referrals in closed loop systems and enhance collaboration between social care service providers and other regional partners.

Job Summary: This position is responsible for establishing trusting relationships with patients while providing support in navigating and accessing resources and engaging patients in goal-driven care. The Community Health Worker systematically identifies, assesses, refers, and monitors high-need individuals to ensure access to essential services while supporting providers and the Care Team through an integrated approach to care management and community outreach.

This position is funded through March 2027.

Organizational Overview: Forward Leading IPA (FLIPA) is a nonprofit membership association of safety net providers working in partnership to provide the highest quality integrated healthcare to historically underserved populations in Upstate New York since 2017. FLIPA is renowned for its commitment to integrating primary care, behavioral health, and social care needs. Our growing membership serves individuals across Upstate NY and includes federally qualified health centers (FQHCs), behavioral health providers, and a rural health network consisting of eight county public health departments.

Equal Employment Opportunity Statement: At Forward Leading IPA (FLIPA), we deeply value diversity in background, experience, and thought. We are committed to creating an environment of belonging where all qualified applicants are encouraged to apply and will receive equal consideration for employment. We do not discriminate based on race, color, religion, age, sex, gender identity or expression, national origin, disability status, veteran status, or any other characteristic protected by federal, state, or local laws.

We believe that fostering spaces of belonging and advancing health equity begins with a workforce that reflects the diverse communities we serve. We actively promote equity of opportunity and strive to ensure that each team member’s unique skills, talents, and potential are recognized and valued. We are dedicated to supporting and welcoming a wide range of candidates, making hiring decisions based solely on individual merit.

FLIPA is committed to prioritizing the human element in healthcare. By embracing diverse perspectives and fostering innovative thinking, we aim to build empowered, healthy, and thriving communities. Join us on this journey and contribute to a mission that makes a meaningful impact.

Security Level: Shared Staff - FLIPA

Duties/Responsibilities:

• Provide a vital link between local communities and healthcare provider by helping individuals access resources and navigate systems.
• Proactively outreach and engage identified individuals in need of services, follow up or social care screening by connecting via phone calls, home visits and/or in-person visits to other settings where patients can be found.
• Support deployment of NYS Social Care Network screening and referral process
• Engage directly with Medicaid individuals to administer the Health-Related Social Needs Screening Tool to identify needed areas of support.
• Facilitate referrals to appropriate community resources and healthcare providers.
• Collaborate with the Care Team to ensure timely follow-up and service linkage.
• Collaborate with treatment teams to ensure preventive services are completed and social needs are met.
• Use designated online referral systems and databases to track and manage client referrals.
• Provide care management related to social care services
• Accurately document in electronic systems and maintain detailed and organized records in compliance with organizational policies and standards.
• Work closely with the Care Team, including care coordinators and other healthcare professionals, to align to a whole person care approach.
• Participate in regular team meetings and contribute insights on client progress.
• Attend regular supervision, staff meetings, trainings and other meetings, as requested.
• Other duties as assigned

Education & Experience:

• Minimum of High School Diploma or GED.
• Currently enrolled in a Bachelor’s or Associate’s degree program
• Majoring in a relevant field (e.g., Marketing, Computer Science, Finance, Engineering, Communications)
• Minimum of 1 year human services experience.

Skills, Knowledge, and Abilities:

• Possess excellent verbal and written communication skills.
• Exceptional customer service skills with commitment to helping others.
• Ability to quickly adapt and be flexible in approach to job tasks and challenges and maintain emotional control under stress.
• Excellent time management skills with exceptional attention to detail and the ability to multi-task and manage multiple priorities with competing deadlines.
• Capability to work cooperatively with culturally diverse clients, staff, and community service providers.
• Basic computer literacy, including the ability to use email, conduct online research, and create basic documents (MS Office Suite including Excel, Outlook and Word).
• NYS motor vehicle license, safe driving record and availability of personal vehicle for work.
• Holds self and others responsible and accountable to meet commitments.

Salary Range:

• Salary is commensurate to education and experience with a range of $18.27 to $28.85 per hour

Additional information:

• This position is an in-person role, embedded within Jordan Health a FLIPA member organization.
• This position will be located at Jordan Health in the Rochester NY area and will sometimes travel between health centers as well as into the community, with partners and for community events.

Job Title: Finger Lakes Community Health (FLCH) Community Health Worker

Reports to: FLIPA Community Health Worker Supervisor and FLCH Director of Care Management

Social Care Network Summary: The New York State Department of Health has established Social Care Networks (SCNs) as part of the 1115 Waiver Demonstration Amendment, The SCN’s aim is to enhance the delivery of social care services to Medicaid members by coordinating efforts among community-based organizations (CBOs) and other health care partners to create a more resilient, flexible, and accessible social care system that reduces health disparities and advances health equity. The SCN will collaborate with CBOs and other health care partners, leveraging shared data and technology to coordinate social care services for Medicaid members to improve access, ensure reliable and timely referrals, streamline and track navigation and completed referrals in closed loop systems and enhance collaboration between social care service providers and other regional partners.

Job Summary: This position is responsible for establishing trusting relationships with patients while providing support in navigating and accessing resources and engaging patients in goal-driven care. The Community Health Worker systematically identifies, assesses, refers, and monitors high-need individuals to ensure access to essential services while supporting providers and the Care Team through an integrated approach to care management and community outreach.

This position is funded through March 2027.

Organizational Overview: Forward Leading IPA (FLIPA) is a nonprofit membership association of safety net providers working in partnership to provide the highest quality integrated healthcare to historically underserved populations in Upstate New York since 2017. FLIPA is renowned for its commitment to integrating primary care, behavioral health, and social care needs. Our growing membership serves individuals across Upstate NY and includes federally qualified health centers (FQHCs), behavioral health providers, and a rural health network consisting of eight county public health departments.

Equal Employment Opportunity Statement: At Forward Leading IPA (FLIPA), we deeply value diversity in background, experience, and thought. We are committed to creating an environment of belonging where all qualified applicants are encouraged to apply and will receive equal consideration for employment. We do not discriminate based on race, color, religion, age, sex, gender identity or expression, national origin, disability status, veteran status, or any other characteristic protected by federal, state, or local laws.

We believe that fostering spaces of belonging and advancing health equity begins with a workforce that reflects the diverse communities we serve. We actively promote equity of opportunity and strive to ensure that each team member’s unique skills, talents, and potential are recognized and valued. We are dedicated to supporting and welcoming a wide range of candidates, making hiring decisions based solely on individual merit.

FLIPA is committed to prioritizing the human element in healthcare. By embracing diverse perspectives and fostering innovative thinking, we aim to build empowered, healthy, and thriving communities. Join us on this journey and contribute to a mission that makes a meaningful impact.

Security Level: Shared Staff - FLIPA

Duties/Responsibilities:

• Provide a vital link between local communities and healthcare provider by helping individuals access resources and navigate systems.
• Proactively outreach and engage identified individuals in need of services, follow up or social care screening by connecting via phone calls, home visits and/or in-person visits to other settings where patients can be found.
• Support deployment of NYS Social Care Network screening and referral process
• Engage directly with Medicaid individuals to administer the Health-Related Social Needs Screening Tool to identify needed areas of support.
• Facilitate referrals to appropriate community resources and healthcare providers.
• Collaborate with the Care Team to ensure timely follow-up and service linkage.
• Use designated online referral systems and databases to track and manage client referrals.
• Provide care management related to social care services
• Accurately document in electronic systems and maintain detailed and organized records in compliance with organizational policies and standards.
• Work closely with the Care Team, including care coordinators and other healthcare professionals, to align to a whole person care approach.
• Participate in regular team meetings and contribute insights on client progress.
• Attend regular supervision, staff meetings, trainings and other meetings, as requested.
• Other duties as assigned

Education & Experience:

• Minimum of High School Diploma or GED.
• Associate's degree in human services, Social Work or other related degree preferred.
• Equivalent experience in lieu of education may be considered.
• Minimum of 1-3 years' human services experience.

Skills, Knowledge, and Abilities:

• Possess excellent verbal and written communication skills.
• Exceptional customer service skills with commitment to helping others.
• Ability to quickly adapt and be flexible in approach to job tasks and challenges and maintain emotional control under stress.
• Excellent time management skills with exceptional attention to detail and the ability to multi-task and manage multiple priorities with competing deadlines.
• Capability to work cooperatively with culturally diverse clients, staff, and community service providers.
• Basic computer literacy, including the ability to use email, conduct online research, and create basic documents (MS Office Suite including Excel, Outlook and Word).
• NYS motor vehicle license, safe driving record and availability of personal vehicle for work.
• Holds self and others responsible and accountable to meet commitments.

Salary Range:

• Salary is commensurate to education and experience with a range of $38,000-$60,000

Additional information:

• This position is an in-person role, embedded within Finger Lakes Community Health, a FLIPA member organization.
• Finger Lakes Community Health has multiple locations in the Finger Lakes region. Exact location is flexible based on employee’s home site.

Job Title: Accountable Health Partners Community Health Worker

Reports To: FLIPA Community Health Worker Supervisor and AHP

Social Care Network Summary: The New York State Department of Health has established Social Care Networks (SCNs) as part of the 1115 Waiver Demonstration Amendment, The SCN’s aim is to enhance the delivery of social care services to Medicaid members by coordinating efforts among community-based organizations (CBOs) and other health care partners to create a more resilient, flexible, and accessible social care system that reduces health disparities and advances health equity. The SCN will collaborate with CBOs and other health care partners, leveraging shared data and technology to coordinate social care services for Medicaid members to improve access, ensure reliable and timely referrals, streamline and track navigation and completed referrals in closed loop systems and enhance collaboration between social care service providers and other regional partners.

Job Summary: This position systematically identifies, assesses, refers, and monitors high-need individuals to ensure access to essential services. By building and maintaining key service connections, the Community Health Worker utilizes a screening tool to identify the health and social needs of Medicaid recipients. This role is pivotal in identifying individuals eligible for Enhanced Health-Related Social Needs (HRSN) Services, facilitating
appropriate referrals and ensuring necessary linkages and support systems are in place. This position is grant-funded through March 2027.

Organizational Overview: Forward Leading IPA (FLIPA) is a nonprofit membership association of safety net providers working in partnership to provide the highest quality integrated healthcare to historically underserved populations in Upstate New York since 2017. FLIPA is renowned for its commitment to integrating primary care, behavioral health, and social care needs. Our growing membership serves individuals across Upstate NY and includes federally qualified health centers (FQHCs), behavioral health providers, and a rural health network consisting of eight county public health departments.

Equal Employment Opportunity Statement: At Forward Leading IPA (FLIPA), we deeply value diversity in background, experience, and thought. We are committed to creating an environment of belonging where all qualified applicants are encouraged to apply and will receive equal consideration for employment. We do not discriminate based on race, color, religion, age, sex, gender identity or expression, national origin, disability status, veteran status, or any other characteristic protected by federal, state, or local laws.

Security Level: Shared Staff - FLIPA

Duties/Responsibilities:

Client Services and Goal Achievement

• Engages directly with individuals seeking assistance.

• Administers the Health-Related Social Needs Screening Tool to identify needed areas of support.

• Short Term involvement with no ongoing caseload.

• Referral and Coordination:

• Facilitate referrals to appropriate community resources and healthcare providers.

• Collaborate with the Care Team to ensure timely follow-up and service linkage.

• Use online referral systems and databases to track and manage client referrals.

Client Advocacy and Support

• Advocate on behalf of clients to access necessary services and address barriers to care.

• Educate clients about available community resources and assist them in navigating healthcare and social service systems.

• Data Management and Reporting:

• Accurately document screening results, referrals, and client interactions in electronic systems.

• Maintain detailed and organized records in compliance with organizational policies and standards.

Collaboration and Team Integration

• Work closely with the Care Team, including care coordinators and other healthcare professionals, to ensure holistic client care.

• Participate in regular team meetings and contribute insights on client progress and community resources.

Community Outreach and Engagement

• Engage with community organizations to strengthen service networks and improve referral pathways.

• Represent the organization at community events and provide outreach to identify individuals in need of services.

• Provide information to community partners on mental health and substance use issues and resources.

• Build relationships with community organizations and service providers.

• Conduct outreach to identify individuals in need of services.

• Represent the organization at community events and stakeholder meetings.

• Other duties as assigned

Education & Experience:

• Minimum of High School Diploma or GED.
• Equivalent experience in lieu of education may be considered.

• Minimum of 1-3 years' human services experience.

Skills, Knowledge, and Abilities:

• Possess excellent verbal and written communication skills.

• Exceptional customer service skills with commitment to helping others.

• Ability to quickly adapt and be flexible in approach to job tasks and challenges and maintain emotional control under stress.

• Excellent time management skills with exceptional attention to detail and the ability to multi-task and manage multiple priorities with competing deadlines.

• Capability to work cooperatively with culturally diverse clients, staff, and community service providers.

• Basic computer literacy, including the ability to use email, conduct online research, and create basic documents (MS Office Suite including Excel, Outlook and Word).
• NYS motor vehicle license, safe driving record and availability of personal vehicle for work.

Pay Range:

• Compensation is based on education and experience, with an hourly range of $18.27–$28.85 (equivalent to $38,000–$60,000 annually for a 40-hour workweek)

Additional information:

• This is a remote position embedded within Accountable Health Partners, a FLIPA member organization. Although primarily remote, the role requires approximately 50% travel and in-community engagement throughout the Finger Lakes region to support community convenings and relationship building. Occasional travel across New York State is also required for on-site meetings, training, and other organizational activities.

Job Title: Oak Orchard Community Health Worker

Reports to: FLIPA Community Health Worker Supervisor and Oak Orchard Patient Engagement Services (PES) Manager

Social Care Network Summary: The New York State Department of Health has established Social Care Networks (SCNs) as part of the 1115 Waiver Demonstration Amendment, The SCN’s aim is to enhance the delivery of social care services to Medicaid members by coordinating efforts among community-based organizations (CBOs) and other health care partners to create a more resilient, flexible, and accessible social care system that reduces health disparities and advances health equity. The SCN will collaborate with CBOs and other health care partners, leveraging shared data and technology to coordinate social care services for Medicaid members to improve access, ensure reliable and timely referrals, streamline and track navigation and completed referrals in closed loop systems and enhance collaboration between social care service providers and other regional partners.

Job Summary: This position is responsible for establishing trusting relationships with patients while providing support in navigating and accessing resources and engaging patients in goal-driven care. The Community Health Worker systematically identifies, assesses, refers, and monitors high-need individuals to ensure access to essential services while supporting providers and the Care Team through an integrated approach to care management and community outreach.

This position is funded through March 2027.

Organizational Overview: Forward Leading IPA (FLIPA) is a nonprofit membership association of safety net providers working in partnership to provide the highest quality integrated healthcare to historically underserved populations in Upstate New York since 2017. FLIPA is renowned for its commitment to integrating primary care, behavioral health, and social care needs. Our growing membership serves individuals across Upstate NY and includes federally qualified health centers (FQHCs), behavioral health providers, and a rural health network consisting of eight county public health departments.

Equal Employment Opportunity Statement: At Forward Leading IPA (FLIPA), we deeply value diversity in background, experience, and thought. We are committed to creating an environment of belonging where all qualified applicants are encouraged to apply and will receive equal consideration for employment. We do not discriminate based on race, color, religion, age, sex, gender identity or expression, national origin, disability status, veteran status, or any other characteristic protected by federal, state, or local laws.

We believe that fostering spaces of belonging and advancing health equity begins with a workforce that reflects the diverse communities we serve. We actively promote equity of opportunity and strive to ensure that each team member’s unique skills, talents, and potential are recognized and valued. We are dedicated to supporting and welcoming a wide range of candidates, making hiring decisions based solely on individual merit.

FLIPA is committed to prioritizing the human element in healthcare. By embracing diverse perspectives and fostering innovative thinking, we aim to build empowered, healthy, and thriving communities. Join us on this journey and contribute to a mission that makes a meaningful impact.

Security Level: Shared Staff - FLIPA

Duties/Responsibilities:

• Provide a vital link between local communities and healthcare provider by helping individuals access resources and navigate systems.
• Proactively outreach and engage identified individuals in need of services, follow up or social care screening by connecting via phone calls, home visits and/or in-person visits to other settings where patients can be found.
• Support deployment of NYS Social Care Network screening and referral process
• Engage directly with Medicaid individuals to administer the Health-Related Social Needs Screening Tool to identify needed areas of support.
• Facilitate referrals to appropriate community resources and healthcare providers.
• Collaborate with the Care Team to ensure timely follow-up and service linkage.
• Use designated online referral systems and databases to track and manage client referrals.
• Provide care management related to social care services
• Assist individuals with transportation in support of obtaining services related to social care needs.
• Accurately document in electronic systems and maintain detailed and organized records in compliance with organizational policies and standards.
• Work closely with the Care Team, including care coordinators and other healthcare professionals, to align to a whole person care approach.
• Participate in regular team meetings and contribute insights on client progress.
• Attend regular supervision, staff meetings, trainings and other meetings, as requested.
• Other duties as assigned

Education & Experience:

• Minimum of High School Diploma or GED.
• Associate's degree in human services, Social Work or other related degree preferred.
• Equivalent experience in lieu of education may be considered.
• Minimum of 1-3 years' human services experience.

Skills, Knowledge, and Abilities:

• Possess excellent verbal and written communication skills.
• Exceptional customer service skills with commitment to helping others.
• Ability to quickly adapt and be flexible in approach to job tasks and challenges and maintain emotional control under stress.
• Excellent time management skills with exceptional attention to detail and the ability to multi-task and manage multiple priorities with competing deadlines.
• Capability to work cooperatively with culturally diverse clients, staff, and community service providers.
• Basic computer literacy, including the ability to use email, conduct online research, and create basic documents (MS Office Suite including Excel, Outlook and Word).
• NYS motor vehicle license, safe driving record and availability of personal vehicle for work.
• Holds self and others responsible and accountable to meet commitments.

Salary Range:

• Salary is commensurate to education and experience with a range of $18.27 to $28.85 per hour

Additional information:

• This position is an in-person role, embedded within Oak Orchard, a FLIPA member organization.
• This position will be located Batavia NY with potential to work at other locations in Genesee County.

Job Title: His Branches Community Health Worker

Reports to: FLIPA Community Health Worker Supervisor and His Branches CHW Supervisor

Social Care Network Summary: The New York State Department of Health has established Social Care Networks (SCNs) as part of the 1115 Waiver Demonstration Amendment, The SCN’s aim is to enhance the delivery of social care services to Medicaid members by coordinating efforts among community-based organizations (CBOs) and other health care partners to create a more resilient, flexible, and accessible social care system that reduces health disparities and advances health equity. The SCN will collaborate with CBOs and other health care partners, leveraging shared data and technology to coordinate social care services for Medicaid members to improve access, ensure reliable and timely referrals, streamline and track navigation and completed referrals in closed loop systems and enhance collaboration between social care service providers and other regional partners.

Job Summary: This position is responsible for establishing trusting relationships with patients while providing support in navigating and accessing resources and engaging patients in goal-driven care. The Community Health Worker systematically identifies, assesses, refers, and monitors high-need individuals to ensure access to essential services while supporting providers and the Care Team through an integrated approach to care management and community outreach.

This position is funded through March 2027.

Organizational Overview: Forward Leading IPA (FLIPA) is a nonprofit membership association of safety net providers working in partnership to provide the highest quality integrated healthcare to historically underserved populations in Upstate New York since 2017. FLIPA is renowned for its commitment to integrating primary care, behavioral health, and social care needs. Our growing membership serves individuals across Upstate NY and includes federally qualified health centers (FQHCs), behavioral health providers, and a rural health network consisting of eight county public health departments.

Equal Employment Opportunity Statement: At Forward Leading IPA (FLIPA), we deeply value diversity in background, experience, and thought. We are committed to creating an environment of belonging where all qualified applicants are encouraged to apply and will receive equal consideration for employment. We do not discriminate based on race, color, religion, age, sex, gender identity or expression, national origin, disability status, veteran status, or any other characteristic protected by federal, state, or local laws.

We believe that fostering spaces of belonging and advancing health equity begins with a workforce that reflects the diverse communities we serve. We actively promote equity of opportunity and strive to ensure that each team member’s unique skills, talents, and potential are recognized and valued. We are dedicated to supporting and welcoming a wide range of candidates, making hiring decisions based solely on individual merit.

FLIPA is committed to prioritizing the human element in healthcare. By embracing diverse perspectives and fostering innovative thinking, we aim to build empowered, healthy, and thriving communities. Join us on this journey and contribute to a mission that makes a meaningful impact.

Security Level: Shared Staff - FLIPA

Duties/Responsibilities:

• Provide a vital link between local communities and healthcare provider by helping individuals access resources and navigate systems.
• Proactively outreach and engage identified individuals in need of services, follow up or social care screening by connecting via phone calls, home visits and/or in-person visits to other settings where patients can be found.
• Support deployment of NYS Social Care Network screening and referral process
• Engage directly with Medicaid individuals to administer the Health-Related Social Needs Screening Tool to identify needed areas of support.
• Facilitate referrals to appropriate community resources and healthcare providers.
• Collaborate with the Care Team to ensure timely follow-up and service linkage.
• Use designated online referral systems and databases to track and manage client referrals.
• Provide care management related to social care services
• Accurately document in electronic systems and maintain detailed and organized records in compliance with organizational policies and standards.
• Work closely with the Care Team, including care coordinators and other healthcare professionals, to align to a whole person care approach.
• Participate in regular team meetings and contribute insights on client progress.
• Attend regular supervision, staff meetings, trainings and other meetings, as requested.
• Other duties as assigned

Education & Experience:

• Minimum of High School Diploma or GED.
• Associate's degree in human services, Social Work or other related degree preferred.
• Equivalent experience in lieu of education may be considered.
• Minimum of 1-3 years' human services experience.

Skills, Knowledge, and Abilities:

• Possess excellent verbal and written communication skills.
• Exceptional customer service skills with commitment to helping others.
• Ability to quickly adapt and be flexible in approach to job tasks and challenges and maintain emotional control under stress.
• Excellent time management skills with exceptional attention to detail and the ability to multi-task and manage multiple priorities with competing deadlines.
• Capability to work cooperatively with culturally diverse clients, staff, and community service providers.
• Basic computer literacy, including the ability to use email, conduct online research, and create basic documents (MS Office Suite including Excel, Outlook and Word).
• NYS motor vehicle license, safe driving record and availability of personal vehicle for work.
• Holds self and others responsible and accountable to meet commitments.

Salary Range:

• Salary is commensurate to education and experience with a range of $18.27 to $28.85 per hour

Additional information:

• This position is an in-person role, embedded within His Branches a FLIPA member organization.
• This position will be located at His Branches in Rochester NY.