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Care Manager II
2 months ago
The Care Manager II is a key member of the Case Management Program team at MetroPlus Health Plan Inc. This role requires a seasoned professional with a strong background in social work and case management. The successful candidate will be responsible for providing high-quality care management services to members, including assessment, planning, implementation, and evaluation of care plans.
Key Responsibilities- Act as a preceptor for new hires within the Integrated Case Management team
- Provide guidance and support to new hires or junior team members
- Develop and present annual research-based presentations to improve the efficiency and quality of care management services
- Address member problems and needs, including clinical, psychosocial, financial, and environmental factors
- Engage members in a collaborative relationship to empower them to self-manage their physical, psychosocial, and environmental health
- Prepare member-oriented plans of care with members, caregivers, and healthcare providers, incorporating 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 other members of the care team, as applicable
- Address gaps in care with members and providers
- Link members to available resources and provide care management support during transitions of care
- Ensure member/caregiver understanding, particularly in cases of language barriers, stress reactions, or cognitive limitations/barriers
- Train members on relevant chronic diseases, preventive care, medication management, home safety, and other relevant topics
- Provide complex care management, including ensuring access to care, reducing unnecessary hospitalizations, and referring to community supports
- Master's degree in social work required
- LMSW/LCSW with current NYS license
- At least one year of experience in a Care Manager Level 1 role within the Integrated Care Management team
- Meet all compliance requirements of Level 1 at 95% for at least ten months over a twelve-month period
- Meet performance goals, measured by quality and productivity
- Satisfactory attendance record
- No substantial Chart Audit tool shortcomings for a ten out of twelve months preceding promotion
- Ability to proficiently read and interpret medical records, claims data, pharmacy, lab reports, and prescriptions
- Ability to travel within the MetroPlusHealth service area, if needed
- Customer Focus
- Functional/Technical skills
- Confident, autonomous, solution-driven, detail-oriented, high standards of excellence, non-judgmental, 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 and ability to prioritize and manage changing priorities under pressure
