Healthcare Navigator
4 days ago
MetroPlusHealth is seeking a highly skilled Care Manager to join our team. As a Care Manager, you will play a critical role in optimizing members' healthcare and delivery of care experience, while achieving cost savings through improved quality of care.
Key Responsibilities- Member Engagement and Assessment
- Engage members in a collaborative relationship, empowering them to self-manage their physical, psychosocial, and environmental health to improve and maintain lifelong well-being.
- Assess and evaluate members' needs, identifying opportunities for care optimization and resource utilization.
- Care Planning and Coordination
- Develop, implement, and evaluate individualized plans of care with members, caregivers, and healthcare providers, integrating concepts of cultural sensitivity and privacy practices.
- Ensure plans of care have individualized goals and interventions, addressing members' clinical, psychosocial, financial, and environmental needs.
- Resource Utilization and Linkage
- Link members to available resources, addressing gaps in care and social determinants of health issues.
- Provide care management support during transitions of care, ensuring seamless coordination and continuity of care.
- Communication and Collaboration
- Communicate plans of care to primary care physicians, ensuring timely and effective care coordination.
- Participate in interdisciplinary rounds, collaborating with healthcare providers and stakeholders to optimize care outcomes.
- Documentation and Reporting
- Maintain accurate, comprehensive, and current clinical and non-clinical documentation in the Care Management System.
- Ensure timely and accurate reporting of care management activities and outcomes.
- Professional Development and Competencies
- Maintain professional competencies as a Care Manager, staying up-to-date with industry best practices and regulatory requirements.
- Participate in ongoing education and training, enhancing skills and knowledge in care management and healthcare navigation.
- Education and Experience
- Bachelor's degree required.
- Minimum 2 years' prior experience in a healthcare setting, care management, or managed care setting required.
- Skills and Competencies
- Ability to proficiently read and interpret medical records, claims data, pharmacy, lab reports, and prescriptions.
- Strong verbal and written communication skills, including motivational coaching, influencing, and negotiation abilities.
- Time management and organizational skills, with ability to prioritize and manage changing priorities under pressure.
- Ability to form effective working relationships with a wide range of individuals, including members, caregivers, and healthcare providers.
- Registered Nurse with current NYS license
- Proficiency with computers, navigating multiple systems and web-based applications
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