Care Manager

3 days ago


Brooklyn, New York, United States MetroPlus Health Plan Full time
About the Role

The Care Manager will play a critical role in optimizing members' healthcare and delivery of care experience with expected cost savings due to improved quality of care.

Key Responsibilities
  • Assess and evaluate members' needs, be a creative, efficient, and resourceful problem solver.
  • Develop, implement, and evaluate plans of care with individualized goals and interventions in collaboration with members' care teams.
  • 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 plans of care with members, caregivers, and healthcare providers, 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.
  • Address members' social determinants of health issues and link members to available resources.
  • Provide care management support during Transitions of Care and ensure member/caregiver understanding as it relates to language barriers, stress reaction, or cognitive limitations/barriers.
  • Train members on relevant chronic diseases, preventive care, medication management, home safety, etc.
  • Advocate for members by assisting them to address challenges and make informed choices regarding clinical status and treatment options.
  • 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.
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.
About MetroPlus Health Plan

MetroPlus Health Plan is 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.


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