Care Manager - MetroPlusHealth : Job Details

Empower New Yorkers by uniting communities through care. We believe that healthcare is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day.

MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products. As a wholly owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlusHealth network includes over 27,000 primary care providers, specialists and participating clinics.

The Care Manager develops, prior approves, facilitates, monitors, and communicates a care plan in partnership with the member, his/her family or significant other, primary caregiver, the primary and/or the attending physicians, and various providers. Using the assessments and interview done by the Assessment Nurse, the Care Manager identifies the risk factors, strengths, challenges, and service needs of the member to keep him/her in their community setting.

• Review and evaluate the assessment and UAS information.
• Develop a working relationship with the PCP to discuss care of the member.
• Review assessment findings risk categories with PCP to identify concerns.
• Identify risk factors and assign the risk category to the member.
• Develop a disaster plan with the team.
• Create a formal care plan for all services needed for the member.
• Monitor the condition of the members by phone or face-to-face.
• Identify clinical issues that require immediate clinical assessment and/or treatment.
• Prior approve request for additional services based on assessments.
• Assist members with the coordination of services within and outside the network.
• Provide Care Coordination through the continuum of care.
• Optimize the quality of care and the quality of life for the MetroPlusHealth members.
• Coordinate with the UM department on concurrent and retrospective review.
• Follow up with assigned nurses for clinical updates to care plan.
• Document coordination notes and routine contacts with the members.
• Participate in team care planning meetings.
• Handle complaints that can be resolved in one day.
• Assist Customer Service and the UM department by providing records and materials.
• Speak to members who are delinquent in their spend-down payments.
• Cooperate with all departments within MetroPlusHealth.
• Identify members appropriate for specialty programs.
• Perform all MLTC management activities in compliance with regulatory agency requirements.
• Provide information to the Manager of MLTCP on requests from the QM department.
• Perform all other tasks assigned by the Director of Long Term Care Clinical Programs or Medical Director.
• Participate in the department on call schedule.

Minimum Qualifications:

• Bachelor's Degree required; BSN preferred.
• Two (2) to three (3) years clinical experience in certified home health agency (CHHA), Lombardi program and/or MLTC.
• Active New York State License as Registered Nurse.

Professional Competencies:

• Integrity & Trust
• Customer Service Focus
• Functional/Technical Skills
• Written/Oral Communication