Care Manager MLTC

3 months ago

New York City, United States MetroPlusHealth Full time
Empower. Unite. Care.

MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care 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.

About NYC Health + Hospitals

MetroPlusHealth 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, MetroPlusHealth network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlusHealth has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.

Position Overview

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.

Job Description
  • Review and evaluate the assessment and UAS information.
  • Develop a working relationship with the PCP to be able to contact and discuss care of the member with the PCP
  • Review assessment findings risk categories with PCP to identify any concerns that have not been identified.
  • Identify the risk factors and assign the risk category to the member.
  • Develops with the team the individual member disaster plan
  • As part of Care Management team develops a formal care plan for all services needed for the member
  • Monitor by phone or when necessary face to face the condition of the members.
  • Identify clinical issues that require immediate clinical assessment and/or treatment to reduce risk of unnecessary hospitalizations, ED visits or nursing home admissions.
  • Prior approve request for additional services based on assessments and using evidence-based standards refer denial, reduction, or limitation of service request to Medical Director.
  • Assist members with the coordination of services both within network and outside network as appropriate. Includes facilitating discharge from acute setting and alternate settings.
  • Provides Care Coordination through continuum of care.
  • Optimizes both the quality of care and the quality of life for the MetroPlusHealth members
  • Coordinate with UM department on concurrent and retrospective review.
  • Follow up with assigned nurses for clinical updates to care plan.
  • Document within two business day’s coordination notes and routine contacts with the members according to the level of risk assigned to them.
  • Participate in team care planning meetings.
  • Handles complains that can be resolved in one day
  • Assists Customer Service and the UM department by providing records and materials needed for grievances from MLTC program members
  • Speaks to members who are delinquent in their spend-down payments.
  • Cooperates with all department within MetroPlusHealth
  • Identifies members appropriate for specialty programs.
  • Performs all MLTC management activities in compliance with all regulatory agency requirements
  • Provides information to the Manager of MLTCP on all requests from QM department to be reviewed by QA committees
  • All other tasks assigned by the Director of Long Term Care Clinical Programs or Medical Director
  • Participates in the department on call schedule/being on call, which is rotated amongst the care team
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

#LI-Hybrid

  • Care Manager MLTC

    3 months ago

    New York, United States MetroPlusHealth Full time

    Job DescriptionJob DescriptionEmpower. Unite. Care.MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care 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.About NYC Health +...

  • Care Manager MLTC

    3 months ago

    New York, United States MetroPlusHealth Full time

    Job DescriptionJob DescriptionEmpower. Unite. Care.MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care 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.About NYC Health +...

  • Care Manager

    4 weeks ago

    New York, United States MetroPlusHealth Full time

    Position Overview 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...

  • Care Manager

    5 days ago

    New York, United States MetroPlus Full time

    Empower. Unite. Care.MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care 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.About NYC Health + HospitalsMetroPlusHealth provides the highest...

  • Care Manager

    4 weeks ago

    New York, United States NYC Health Hospitals Full time

    MetroPlusHealth 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...

  • Care Manager

    2 weeks ago

    New York, United States MetroPlusHealth Full time

    Empower. Unite. Care. MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care 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. About NYC Health + Hospitals MetroPlusHealth provides the highest...

  • Care Manager

    5 days ago

    New York, United States MetroPlusHealth Full time

    Job DescriptionJob DescriptionEmpower. Unite. Care.MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care 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.About NYC Health +...

  • UAS Assessment RN

    1 week ago

    New York, United States Compass Healthcare Consulting & Placement Full time

    Compass Healthcare Consulting & Placement is conducting a search for experienced UAS Assessment RNs for a Managed Care Plan servicing New York. Assessments are in-person or telephonic (only if patient requires and documentation provides justification for telephonic visit) . Qualified candidates will have prior UAS/MLTC RN experience an HCS/UAS-NY Account...

  • RN Care Manager Managed Long Term Care

    3 weeks ago

    New York, United States MetroPlusHealth Full time

    Job Description Empower. Unite. Care. MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care 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. About NYC Health + Hospitals MetroPlusHealth...

  • RN Care Manager Managed Long Term Care

    4 weeks ago

    New York, United States NYC Health + Hospitals Full time

    Job DescriptionMarketing StatementMetroPlusHealth 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,...

  • RN Care Manager Managed Long Term Care

    4 weeks ago

    New York, United States NYC Health Hospitals Full time

    MetroPlusHealth 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...

  • RN Care Manager Managed Long Term Care

    1 month ago

    New York, United States NYC Health + Hospitals Full time

    Job DescriptionMarketing StatementMetroPlusHealth 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,...

  • Care Manager

    4 days ago

    New York, New York, United States Village Care Full time

    Job OverviewVillageCare is seeking a highly motivated and detail-oriented Care Manager to join our team in a remote full-time opportunity. This position will provide telephonic assessments, develop, implement, and monitor care plans for our members.About the RoleThis role involves providing all aspects of care management, including planning, coordination,...

  • Care Management Navigator

    2 days ago

    New York, United States VNS Health Full time

    Overview Provides support to the Care Coordinators and other staff in the resolution of member related issues. Communicates with members and their families regarding information about MLTC services. Provides summary reports, analysis and support for care coordination related activities. Participates in non-clinical customer service for members enrolled in...

  • RN Care Manager Managed Long Term Care

    4 weeks ago

    New York, United States MetroPlusHealth Full time

    Job DescriptionEmpower. Unite. Care.MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care 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.About NYC Health + HospitalsMetroPlusHealth provides...

  • RN Care Manager Managed Long Term Care

    4 weeks ago

    New York, United States MetroPlusHealth Full time

    Empower. Unite. Care. MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care 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. About NYC Health + Hospitals MetroPlusHealth provides the highest...

  • RN Care Manager Managed Long Term Care

    1 month ago

    New York, United States MetroPlusHealth Full time

    Job DescriptionEmpower. Unite. Care.MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care 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.About NYC Health + HospitalsMetroPlusHealth provides...

  • UAS Assessment RN

    5 days ago

    New York, NY, United States Compass Healthcare Consulting & Placement Full time

    Compass Healthcare Consulting & Placement is conducting a search for experienced UAS Assessment RNs for a Managed Care Plan servicing New York. Assessments are in-person or telephonic (only if patient requires and documentation provides justification for telephonic visit) . Qualified candidates will have prior UAS/MLTC RN experience an HCS/UAS-NY Account...

  • Care Management Navigator, Bilingual

    2 days ago

    New York, United States VNS Health Full time

    Overview Provides support to the Care Coordinators and other staff in the resolution of member related issues. Communicates with members and their families regarding information about MLTC services. Provides summary reports, analysis and support for care coordination related activities. Participates in non-clinical customer service for members enrolled in...

  • Care Management Navigator, Bilingual

    4 weeks ago

    New York, United States VNS Health Full time

    Provides support to the Care Coordinators and other staff in the resolution of member related issues. Communicates with members and their families regarding information about MLTC services. Provides summary reports, analysis and support for care coor Management, Bilingual, Navigator, Customer Service, Healthcare, Care Coordinator