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Job Title: Director of Data Analytics

Reports To: Chief Operating Officer

Job Summary: The Director of Data Analytics is responsible for enterprise analytics strategy, data governance, healthcare intelligence, and performance measurement. This role drives data-informed decision-making across value-based care, population health, quality improvement, care management, and financial performance initiatives. The Director partners with executive leadership, member organizations, and external stakeholders to transform complex healthcare data into actionable insights that improve outcomes, reduce costs, and advance FLIPA's strategic objectives.

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.

Security Level: Leadership

Duties/ Responsibilities:

• Operational Leadership:
• Develop and maintain a multi-year analytics roadmap aligned with organizational priorities and value-based care objectives.
• Collaborate with leadership to implement key performance indicators (KPIs) and tracking systems to evaluate the impact of FLIPA initiatives.
• Partner with clinical, operational, and executive leaders to identify data-driven opportunities and develop analytic solutions.
• Serve as a trusted advisor to the Executive Leadership team.
• Present analytics findings to the Board of Directors, executive committees, and member organization leaders.
• Translate organizational strategy into measurable performance objectives and dashboards.
• Provide thought leadership regarding emerging healthcare analytics trends and technologies.
• Performance Management:
• Collaborate with member organizations to promote the adoption of data tools, value-based care (VBC) insights, and performance improvement initiatives.
• Translate complex data insights into clear, actionable recommendations for diverse stakeholder audiences.
• Lead analytics project planning and execution, coordinating timelines, deliverables, and stakeholder engagement across internal and external partners.
• Provide analytic support and performance reporting for value-based payment arrangements, shared savings programs, and managed care contracts.
• Identify areas for performance improvement and work collaboratively with stakeholders to implement solutions.
• Engage with providers, administrators, and other partners to understand their data needs and address analytic challenges.
• Compliance and Quality Assurance:
• Collaborate with data engineering, technology, and information security teams to promote data integrity, security, and regulatory compliance.
• Stay informed on emerging trends in data analytics, healthcare informatics, and advanced technologies.
• Monitor regulatory developments, evolving data standards, and industry benchmarks to inform strategy and compliance.
• Enterprise Data Governance
• Collaborate with Information Security Officer to establish and maintain enterprise data governance frameworks.
• Define data quality standards, stewardship processes, and master data management practices.
• Chair data governance committees and oversee organizational data policies.
• Ensure consistency of data definitions and reporting methodologies across the organization.
• Team Development:
• Manage, mentor, and support a team of data analysts and support staff through coaching, feedback, and professional development.
• Establish performance expectations, workforce planning, and succession development for the analytics function.
• Foster a collaborative, innovative, and high-performing team environment committed to continuous improvement.
• Evaluate and recommend new tools, techniques, and methodologies to enhance FLIPA’s analytic capabilities.
• Perform other duties as assigned.

Education & Experience:

• Bachelor’s or Master’s degree in Data Science, Health Informatics, Statistics, Computer Science, Epidemiology, Public Health, or related field, or equivalent experience.
• 5+ years of healthcare data analytics experience, including a minimum of 2 years in a leadership or strategic data role.
• Proven experience as Director of Data Analytics or equivalent position
• Demonstrated success supporting value-based care organizations, payers, IPA/CIN networks, ACOs, or FQHCs.
• Experience within the New York State health care system (population health, behavioral health, Federally Qualified Health Centers, or similar) required.

Skills, Knowledge, and Abilities:

• Ability to support team in strong command of SQL, Python, etc. for data extraction, transformation, and analysis.
• Expertise with Power BI, data modeling, and Azure for warehousing leadership.
• Experience designing and overseeing modern cloud-based healthcare analytics platforms and business intelligence ecosystems.
• Advanced knowledge of healthcare performance measurement, HEDIS, STAR Ratings, quality improvement methodologies, risk adjustment, attribution methodologies, and value-based reimbursement models.
• Strong knowledge of data management principles. Microsoft Purview experience recommended.
• Excellent analytical and problem-solving skills, with the ability to translate complex data into actionable insights for business intelligence.
• Strong leadership and team management abilities, with a track record of building and motivating high-performing teams.
• Skilled in translating complex technical data into accessible insights for executive and clinical audiences.
• Excellent project management and organizational skills.
• Knowledge of healthcare regulations and compliance requirements (e.g., HIPAA) is required.

Additional information:

• This position will be remote with periodic required in-person meetings.
• This role offers an opportunity to shape the future of healthcare delivery across Upstate New York by leveraging advanced analytics to improve outcomes, reduce disparities, and support safety-net providers participating in value-based care transformation.

Job Title: Population Health Coordinator

Reports to: Director of Quality

Job Summary:

This position is responsible for supporting FLIPA in the successful deployment of Population Health Management (PHM) initiatives across the network. The Population Health Coordinator will work collaboratively with FLIPA’s Value Based Care team and stakeholders across the network to support FLIPA’s success with PHM initiatives. This includes serving as a point of contact for external partners, supporting data collection, and supporting implementation of PHM initiatives. This role will leverage data to identify opportunities, measure outcomes, and drive quality improvement, while supporting stakeholders in navigating tools, resources, and requirements.

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: Standard - FLIPA

Duties/Responsibilities:

• Support the Director of Quality to develop and manage project schedules, develop workplans and align resources required to meet objectives for assigned projects through the Value Based Care arm of FLIPA.

• Provide project management for FLIPA’s population health initiatives as directed through value based contracts, grant funded programs and other projects, as assigned.
• Serve as a point of contact for external stakeholders, supporting data collection and implementation efforts related to population health initiatives.
• Collaborate across multiple organizations and geographies to support project management within different organizational cultures, structures, and communities.
• Support external stakeholders in navigating population health platforms and front-end data interfaces, ensuring effective use of available tools and data.
• Support the implementation of FLIPA’s Performance Management Committee including meeting coordination, content development, documentation of outcomes, and tracking deliverables
• Provide quality improvement support to stakeholders, including project management, workflow development, process improvement, results summaries, and data visualization.
• Partner with FLIPA data team to define data analytic requirements for project evaluation as needed.
• Organize and validate population health data sets to support the Value Based Care team in identifying trends and areas for quality improvement.

• Other duties as assigned.

Education & Experience:

Bachelor’s degree in a related field, such as public health, healthcare administration, business, or equivalent experience required

• 2+ years of project management or related experience required

• Master’s degree in a related field, such as public health, healthcare administration, business, or equivalent experience required (preferred)

• 0-2 years of project management or related experience required

• Experience within the New York State health care system (population health, behavioral health, Federally Qualified Health Centers, or similar) required

• Experience with population health

Skills, Knowledge, and Abilities:

• Excellent organizational skills with the ability to manage multiple priorities and deliver projects on time.

• Effective communicator with strong interpersonal skills and the ability to collaborate with internal teams and external stakeholders in a remote work environment

• Proficient with Microsoft Office Suite (including Teams) and familiar with project management software tools

• Flexible, resourceful, and able to navigate last minute changes and project pivots

• Thrives on creative problem-solving

• Working knowledge of population health concepts and/or ability to learn and support the use of data platforms and tools

• Ability to explore, understand, and communicate data in a meaningful way to diverse audiences

Salary Range:

• Salary is commensurate to education and experience with a range of $65,000 – $75,000.

Additional information:

• Candidates located in the state of New York are preferred.
• This position will be remote with periodic required in-person meetings.

Title: Care Manager Navigator – Member Services

Reports To: CHW Supervisor & Care Management Performance Manager
Location: Hybrid (Periodic in-person meetings required)

About Forward Leading IPA (FLIPA)

Forward Leading IPA (FLIPA) is a nonprofit membership association of safety net providers dedicated to improving healthcare outcomes for underserved populations across Upstate New York. Through integrated primary care, behavioral health, and social care services, FLIPA works collaboratively with healthcare providers and community organizations to address the whole-person needs of the communities we serve.

Position Summary

The Care Manager Navigator is responsible for supporting members with social care needs through care coordination, resource navigation, and referral management. This role helps ensure members receive timely access to services, addresses barriers to care, and collaborates with healthcare and community partners to improve outcomes across FLIPA's Social Care Network.

Key Responsibilities

• Conduct member outreach, assessments, and ongoing care coordination.
• Develop and maintain individualized care plans.
• Coordinate and track referrals to healthcare providers and community resources.
• Monitor member engagement and address barriers to service access.
• Collaborate with internal teams, managed care organizations, providers, and community partners.
• Maintain accurate and timely documentation in required systems.
• Identify and escalate complex cases, compliance concerns, or service gaps.
• Support quality improvement initiatives and network-wide coordination efforts.

Qualifications

Required:

• Bachelor's degree in social work, Human Services, Public Health, Nursing, Psychology, or a related field.
• Two (2) years of experience in care management, case management, care coordination, social services, or a related field.
• Strong communication, organizational, and documentation skills.
• Ability to manage multiple priorities while working collaboratively across teams.

Preferred:

• Experience with Medicaid, managed care, healthcare, or social care programs.
• Familiarity with care management platforms and electronic documentation systems.
• Bilingual candidates are encouraged to apply.

Compensation

$24.00 – $25.00 per hour, commensurate with education and experience.

Benefits

• 401(k) with Company Match
• Medical Insurance
• Dental Insurance
• Vision Insurance
• Health Savings Account (HSA)
• Flexible Spending Account (FSA)
• Paid Time Off (PTO)
• Flexible Schedule
• Mileage Reimbursement

Job Title: SCN Enhanced Care Manager

Reports to: TBD

Location: Hybrid with periodic required in-person meetings.

About Forward Leading IPA:

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.

Position Summary:

The Enhanced Care Manager serves as a dedicated care management resource supporting high risk/specialty population members who are eligible to receive enhanced services across the Social Care Network (SCN), including maternal-child health (MCH), postpartum individuals, children and youth, members requiring asthma remediation services, and sensitive conditions population including SUD, SMI, and IDD. This position operates within SCN's Internal Hub using a hybrid embedded model that combines direct community-based engagement with centralized care coordination activities.

The Enhanced Care Manager is responsible for completing Health Related Social Needs (HRSN) screening and Eligibility Assessment, care planning, referral management, cross-sector collaboration, member engagement, service coordination, and outcome tracking. This role helps SCN fulfill its commitment to improving health outcomes and reducing barriers for vulnerable populations.

Key Responsibilities

• Manage a dedicated caseload of members within identified high-risk and specialty populations.
• Complete screenings and assessments to identify members’ health-related social needs, eligibility, and service needs.
• Develop, implement, and update individualized care plans based on each member’s needs, goals, and available resources.
• Connect members to appropriate providers, programs, community resources, and social care services.
• Monitor member progress, referral outcomes, and service engagement throughout the care management process.
• Provide ongoing support, education, and follow-up to help members navigate services and reduce barriers to care.
• Facilitate warm handoffs to appropriate services and community-based supports.
• Build and maintain trusted relationships with members, families, healthcare providers, and community partners.
• Participate in multidisciplinary case reviews, care conferences, and collaborative planning meetings as needed.
• Work onsite or in coordination with partner organizations, including OB/GYN practices, WIC offices, Federally Qualified Health Centers, schools, home visiting programs, and community-based organizations.

Hub-Based Responsibilities

• Coordinate referrals, service follow-up, and communication across internal and external partners.
• Conduct care plan reviews and support ongoing care management activities through SCN-approved processes.
• Maintain regular communication and collaboration with healthcare providers, community organizations, and internal team members.
• Use multiple systems, workflows, and documentation processes to support timely and accurate care coordination.
• Document all member interactions, referrals, care management activities, and follow-up actions in SCN-approved systems.

Quality and Compliance

• Maintain accurate, timely, and complete documentation in accordance with SCN, organizational, and regulatory requirements.
• Ensure care management activities are completed in alignment with applicable program standards and compliance expectations.
• Track referral outcomes, service completion, member engagement, and barriers to care.
• Support reporting, performance monitoring, and quality improvement initiatives related to care management services.
• Protect member confidentiality and handle sensitive information in accordance with applicable privacy requirements.

Qualifications:

• Bachelor’s degree in social work, Human Services, Public Health, Nursing, Psychology, or a related field.
• Minimum of two years of experience in care management, case management, care coordination, community health, social services, or a related area.
• Experience working with vulnerable, high-need, or underserved populations.
• Knowledge of community resources, healthcare systems, social service systems, and referral processes.
• Strong communication, organization, documentation, and relationship-building skills.
• Ability to work independently, manage multiple priorities, and collaborate effectively with internal and external partners.

Preferred Qualifications:

• Experience in maternal and child health, behavioral health, substance use services, developmental disability services, or other specialty population programs.
• Knowledge of New York State Medicaid, managed care, Social Care Networks, or health-related social needs programming.
• Care management certification, community health worker certification, or equivalent professional credential.
• Bilingual or multilingual abilities.
• Care coordination and care management
• Trauma-informed and person-centered engagement
• Community partnership development
• Member advocacy and resource navigation
• Documentation, compliance, and confidentiality
• Communication, organization, and time management
• Problem-solving, critical thinking, and sound judgment
• Collaboration across healthcare, social service, and community-based partners

Compensation Range:

• Compensation is commensurate with education and experience. The position offers a salary of $55,000 annually, equivalent to approximately $26.44 per hour.

Benefits

• 401(k) with Company Match
• Medical Insurance
• Dental Insurance
• Vision Insurance
• Health Savings Account (HSA)
• Flexible Spending Account (FSA)
• Paid Time Off (PTO)
• Mileage Reimbursement

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 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 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: 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.