MetroPlus Case Manager I

MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlusHealth's network includes over 27,000 primary care providers, specialists and participating clinics. For more than 40 years, MetroPlusHealth has been committed to building strong relationships with its members and providers.

The primary goal of the Care Manager is to optimize members’ health care and delivery of care experience with expected cost savings due to improved quality of care. This is accomplished through engagement and understanding of the members’ needs, environment, providers, support system and optimization of services available to them. Care Manager is expected to assess and evaluate member’s needs, be a creative, efficient, and resourceful problem solver. In collaboration with the members’ care team, a plan of care with individualized goals and interventions is developed, implemented and evaluated outcomes.

9:00 A.M – 5:00 P.M

• Members’ problems and needs: clinical, psychosocial, financial, environmental

• Provide services to members of varying age, risk level, clinical scenario, culture, financial means, social support, and motivation
• 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 plan of care with members, caregivers, and health care providers, integrating concepts of cultural sensitivity and privacy practices
• Participate in interdisciplinary rounds
• Ensure plans of care have individualized goals and interventions
• Communication plan of care to Primary Care Physician

• Address gaps in care with the member and provider

• Address members social determinants of health issues

• Link members to available resources

• Provide care management support during Transitions of Care
• 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 (medication reconciliation and adherence), home safety, etc.
• Provide Complex care management including but not limited to; ensuring 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

• Employ critical thinking and judgment when dealing with unplanned issues

• 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

• Other duties as assigned by Directors.

1. One (1) year of experience in case management, care coordination, discharge planning, utilization management/review, quality assurance/management, or a closely related area in a health or managed care setting; and a doctoral degree in Psychology or a related discipline from an accredited college or university, or one of the following may be substituted for a doctoral degree:
a. A valid Credentialed Alcoholism and Substance Abuse Counselor (CASAC) Level I, Level II, Advanced, or Master issued by the NYS Office of Addiction Services and Supports (OASAS).
b. A valid license and current registration to practice as a Licensed Mental Health Counselor (LMHC), Licensed Master Social Worker (LMSW), or Licensed Clinical Social Worker (LCSW) issued by the New York State Education Department (NYSED).

2. Positions supporting behavioral health, Health and Recovery Plan (HARP), and children’s special services functions require three (3) years of experience, as described in 1. above, and a valid license and current registration to practice as a Licensed Mental Health Counselor (LMHC), Licensed Marriage and Family Therapist (LMFT), Licensed Master Social Worker (LMSW), or Licensed Clinical Social Worker (LCSW) issued by the New York State Education Department (NYSED).

NYC Health and Hospitals offers a competitive benefits package that includes:

• Comprehensive Health Benefits for employees hired to work 20+ hrs. per week
• Retirement Savings and Pension Plans
• Paid Holidays and Vacation in accordance with employees' Collectively bargained contracts
• Loan Forgiveness Programs for eligible employees
• College tuition discounts and professional development opportunities
• College Savings Program
• Union Benefits for eligible titles
• Multiple employee discounts programs
• Commuter Benefits Programs