Care Manager
3 weeks ago
At MetroPlusHealth, we are committed to empowering 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.
About MetroPlusHealthMetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens, and Staten Island through a comprehensive list of products, including New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, and more. 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, MetroPlus has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.
Job OverviewThe primary goal of the Care Manager is to optimize members' healthcare 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. The Care Manager is expected to assess and evaluate member's needs, be a creative, efficient, and resourceful problem solver. The Care Manager serves as member's advocate and accompanies the member throughout their care journey.
Key Responsibilities- Physically meet the members where they are to gain deep understanding of their situation and needs
- Problem solve member's problems and needs: clinical, psychosocial, financial, environmental
- Provide services to members of varying age, clinical scenario, culture, financial means, social support, and motivation
- Engage members in a collaborative relationship, empowering them to manage their physical, psychosocial, and environmental health to improve and maintain lifelong well-being
- Assess risks and gaps in care
- Maximize member's access to available resources
- Prepare member-oriented plan of care with member, caregivers, and healthcare providers, integrating concepts of cultural sensitivity and privacy practices
- Communicate plan of care to Primary Care Physician initially and no less than monthly with updates
- Ensure member caregiver understanding as it relates to language barriers, stress reaction, or cognitive limitations/barriers using verbal and nonverbal techniques
- Train member on relevant chronic diseases, preventive care, medication management (medication adherence), home safety, etc.
- Provide Complex care management including but not limited to; insuring 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
- Develop collaborative relationships with clinical providers and facility staff
- Employ critical thinking and judgment when dealing with unplanned issues
- Ability to use data as a tool in tracking and trending outcomes and clinical information
- Maintain accurate, comprehensive, and current clinical and non-clinical documents
- 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 Team Lead and Manager
- Master's Degree required
- Minimum 3 years' in prior experience in Case Management in a healthcare and/or Managed Care setting strongly preferred
- Experience providing care management or care coordination required, managing both medical and psychosocial needs of clients
- Proficiency with computers navigating in multiple systems and web-based applications
- Ability to proficiently read and interpret medical records, claims data, pharmacy and lab reports, and prescriptions required
- Ability to travel within the MetroPlusHealth service area making home visits to members, facility visits to clinical providers, and visits to community, faith, and other social service-based agencies
- Ability to work closely with member and caregiver
- LMSW/LCSW with current NYS license
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