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MetroPlus Health PlanNew York, NY Full-time
- About NYC Health + Hospitals
- MetroPlus Health Plan provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc.
- As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlus’ network includes over 27,000 primary care providers, specialists and participating clinics.
- For more than 30 years, MetroPlus has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.
- The primary goal of the Care Manager is to optimize members’ health care and delivery of care experience with expected cost savings due to improved quality of care.
- This is accomplished through engagement and understanding of the member’s needs, environment, providers, support system and optimization of services available to them.
- Care Manager is expected to assess and evaluate member’s needs, be a creative, efficient and resourceful problem solver.
- In collaboration with the members’ care team, a plan of care with individualized goals and interventions is developed, implemented and outcomes evaluated.
- Address member’s problems and needs: clinical, psychosocial, financial, environmental
- Provide services to members of varying age, risk level, clinical scenario, culture, financial means, social support, and motivation
- Engage members in a collaborative relationship, empowering them to self-manage their physical, psychosocial and environmental health to improve and maintain lifelong well being
- Prepare member-oriented plan of care with member, caregivers, and health care providers, integrating concepts of cultural sensitivity and privacy practices
- Participate in interdisciplinary rounds
- Ensure plans of care have individualized goals and interventions
- Communicate plan of care to Primary Care Physician
- Address gaps in care with the member and provider
- Address members social determinants of health issues
- Link members to available resources
- Provide care management support during Transitions of Care
- Ensure member/caregiver understanding as it relates to language barriers, stress reaction or cognitive limitations/barriers
- Train member on relevant chronic diseases, preventive care, medication management (medication reconciliation and adherence), home safety, etc.
- Provide Complex care management including but not limited to; ensuring access to care, reducing unnecessary hospitalizations, and appropriately referring to community supports
- Advocate for members by assisting them to address challenges and make informed choices regarding clinical status and treatment options
- Employ critical thinking and judgment when dealing with unplanned issues
- Maintain knowledge of Chronic Conditions and use job aids as a guidance
- Maintain accurate, comprehensive and current clinical and non-clinical documentation in DCMS, the Care Management System
- Comply with all orientation requirements, annual and other mandatory trainings, organizational and departmental policies and procedures, and actively participate in evaluation process
- Maintain professional competencies as a Care Manager
- Other duties as assigned by Manager
- Background: Registered Nurse, Bachelor’s Degree in Nursing required
- An equivalent combination of training, educational background, and experience in related fields such as hospital, home care, ambulatory setting and educational disciplines.
- Prior experience in Care Management in a health care and/or Managed Care setting preferred
- Proficiency with computers navigating in multiple systems and web- based applications
- Confident, autonomous, solution driven, detail oriented, high standards of excellence, nonjudgmental, diplomatic, resourceful, intuitive, dedicated, resilient and proactive
- Strong verbal and written communication skills including motivational coaching, influencing and negotiation abilities
- Time management and organizational skills
- Strong problem-solving skills
- Ability to prioritize and manage changing priorities under pressure
- Must know how to use Microsoft Office applications including Word, Excel, and PowerPoint and Outlook.
- Ability to proficiently read and interpret medical records, claims data, pharmacy, lab reports and prescriptions required
- If needed, ability to travel within the MetroPlus service area to participate in facility visits, community events, home visits or other community meetings, including conferences.
- Registered Nurse or LMSW/LCSW with current NYS license