About Us:

Cityblock Health is the first tech-driven provider for communities with complex needs—bringing better care to where it’s needed most, block by block. Founded in 2017 on the premise that “health is local” and based in Brooklyn, we are backed by Alphabet’s Sidewalk Labs along with some of the top healthcare investors in the country.

Our mission is to improve the health of underserved communities. Importantly, our solutions are designed specifically for Medicaid and lower-income Medicare beneficiaries, and we meet our members where they are, bringing care into the home and neighborhoods through our community-based care teams and Virtual Care offerings.

In close collaboration with community-based organizations, local providers, and leading health plans, we are reorganizing the health system to focus on what matters to our members. Equipped with world-class, custom care delivery technology, we deliver personalized primary care, behavioral health, and social services to deliver a radically better experience of care for every member and community we serve.

Over the next year, we’ll grow quickly to bring better care to many more members and their communities. To do this, we need people who, like us, believe that everyone should have good care for what matters to them, in their community.

Our work is grounded in a belief in the power of a diverse community. To close gaps in care and advance equity in the communities we serve, we have to start with making our own team diverse and inclusive. Our ways of working are characterized by creativity, collaboration, and mutual learning that comes from bringing together a community from diverse backgrounds and perspectives. We strive to ensure that every person on the Cityblock team, and every Cityblock member, feels supported and included as a part of our community.

Our Values:

• Aim for Understanding
• Be All In
• Bring Your Whole Self
• Lean Into Discomfort
• Put Members First

About our Team:

We employ a field-based, home-based care model and are committed to meeting members where they are--in their homes, in their community, and in our Hubs. You will go above and beyond to connect with Cityblock members in a non-judgmental, respectful and empathic manner, to meet their needs, and to provide feedback to the system as a whole as we strive to do better every day.

About the Role:

Behavioral health services and care programming are available to all Cityblock members. The Behavioral Health Community Health Partner (BH CHP) will manage a member panel to support care coordination and social care for high-complexity members with acute behavioral health conditions. The role works closely with members of the behavioral health team, including the Behavioral Health Specialist and Psych specialists, along with members of the longitudinal care team.

• Engagement
  • Receive members from engagement and care teams
  • Describe program expectations (e.g., length) and goals to members
• Assess/Intake
  • Complete assessment and screening instruments (including for behavioral health, home safety and social needs) following protocols
    • Collaborate with psychiatrist, RN and Behavioral Health Specialist (BHS) as needed
• Case Review and Care Planning
  • Partner with the BHS and Psych APC to develop members’ care plans
  • Support members in achieving their care plan goals
    • Work with members to create goals in care plans and coach to completion
  • Case conference prep with BHS
  • Active participant, with the ability to present key and vital information during case conferences and lead discussion as needed
  • Participate in regular Advanced Behavioral Health program huddles
• Follow-up
  • Weekly check-ins with members to follow-up on care coordination needs (benefits, social needs, external care) and care plan progress
  • Frequent touchpoints and tight coordination with external providers and community based organizations
  • Work with RN and pharmacies to coordinate in-home medication administrations
  • Collaborate with BHS and Psych APC to determine need for escalation of member care
  • Address and respond to member needs and delegate tasks in timely fashion
  • Meet with members in the community (home, short-term nursing facility shelter, hospital) as needed, including as an extender of the care team for non-clinical needs
• Operations
  • Utilize our care facilitation, electronic health record and scheduling platforms as needed to collect data, document member interactions, organize information, track tasks, and communicate with your team, members, and community resources

Requirements for the Role:

• HS Diploma
• Experience working with individuals with behavioral health conditions
• Unrestricted Driver’s License and Vehicle for daily use
• Knowledge of operations, understanding of change management, ability to adapt
• Proficient user of Cityblock applications and navigates quickly across systems by developing useful shortcuts/workflows
• Can foster trust quickly over the phone
• Demonstrated strong Engagement Skills
• Demonstrated awareness to find out more about members and provide a better service.
• Ability to communicate information and ideas clearly and articulately both in oral and written form.
• Demonstrated use of appropriate language, style and methods depending on the audience and the purpose of communication.
• Able to convey complex information clearly.
• Anticipate the information that others will need

What We’d Like From You:

• A resume and/or LinkedIn profile

Cityblock values diversity as a core tenet of the work we do and the populations we serve. We are an equal opportunity employer, indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic.

-

We do not accept unsolicited resumes from outside recruiters/placement agencies. Cityblock will not pay fees associated with resumes presented through unsolicited means.