Forward Leading Independent Provider Association (FLIPA)

General

• Engages directly with individuals seeking assistance.
• Administers 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.
• Advocate on behalf of clients to access necessary services and address barriers to care.
• Accurately document screening results, referrals, and client interactions in electronic systems.
• Work closely with the Care Team, including care coordinators and other healthcare professionals, to ensure holistic client care.
• Engage with community organizations to strengthen service networks and improve referral pathways.

Community Health Worker

Manager

• 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.
• 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.
• 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.
• Review operational, encounter, quality, and outcome data.
• Collaborate with analytics teams to evaluate housing services performance
• Support corrective action planning when performance issues arise.
• Coordinate with Care Navigation, Network Management, Compliance, IT, and Quality teams
• Support complex housing cases requiring higher‑level coordination.
• Perform additional related responsibilities as needed to support the goals of the Social Care Network initiative.

Community Health Worker

Social Care Network Housing Performance Manager