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Healthcare Navigator

2 months ago

New York, New York, United States MetroPlusHealth Full time
Job Summary

MetroPlusHealth is seeking a skilled Care Manager to optimize members' healthcare experience and delivery of care while achieving cost savings through improved quality of care.

Key Responsibilities
  • Assess and evaluate members' needs, providing creative, efficient, and resourceful problem-solving solutions.
  • Develop, implement, and evaluate individualized plans of care in collaboration with members' care teams.
  • Engage members in a collaborative relationship, empowering them to self-manage their physical, psychosocial, and environmental health.
  • Prepare member-oriented plans of care, integrating concepts of cultural sensitivity and privacy practices.
  • Participate in interdisciplinary rounds and ensure plans of care have individualized goals and interventions.
  • Communicate plans of care to Primary Care Physicians and address gaps in care with members and providers.
  • Link members to available resources and address social determinants of health issues.
  • Provide care management support during Transitions of Care and ensure member/caregiver understanding.
  • Train members on relevant chronic diseases, preventive care, medication management, and home safety.
  • Advocate for members by assisting them to address challenges and make informed choices regarding clinical status and treatment options.
  • 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 processes.
Requirements
  • Bachelor's Degree required.
  • Minimum 2 years' prior experience in a healthcare setting, Care Management, or Managed Care setting required.
  • Ability to proficiently read and interpret medical records, claims data, pharmacy, lab reports, and prescriptions required.
  • Registered Nurse with current NYS license.
Professional Competencies
  • Integrity and Trust.
  • Customer Focus.
  • 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.
  • Ability to form effective working relationships with a wide range of individuals.