Job Ref: 126709
Category: Utilization Review and Case Management
Department: BEHAVIORAL HEALTH HARP
Location: 50 Water Street, 7th Floor,
New York,
NY 10004
Job Type: Regular
Employment Type: Full-Time
Hire In Rate: $83,000.00
Salary Range: $83,000.00 - $83,000.00
MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care 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.
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 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.
Position Overview:
MetroPlusHealthis committed to empowering New Yorkers by uniting communities through care. We believe that Health care 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.
The Behavioral Health Care Manager develops, facilitates, and communicates a plan of care in partnership with the member, their assigned Health Home, primary caregiver, the primary and attending physicians, and various Behavioral Health and/or Substance Use Disorder providers. This position collaborates with the aforementioned parties to assess, plan, facilitate, and advocate for options and services to meet a member’s behavioral health needs through communication and available resources.
9:00 A.M – 5:00 P.M
• Clinically assess members for acute behavioral and physical health needs. Generating referrals to providers, community-based resources, and appropriate services and other resources to assist in goal achievement.
• Expected to meet with members in their homes, shelters, other residential settings, at community agencies, hospital inpatient units and/or day hospital programs.
• Conduct initial and ongoing Behavioral Health clinical assessments.
• Develop a formal plan of care for all services needed for the member.
• Notify physicians for any changes in member’s plan of care. Follow up with assigned nurses for clinical updates to plans of care.
• Document IDT care coordination notes between both internal MetroPlusHealth staff and external BH providers and caregivers.
• Attend and prepare for bi-Weekly Interdisciplinary Care Team (ICT) meetings which will feature newly enrolled, frequently admitted, high utilizing at risk members.
• Assist members with the coordination of services from various settings as appropriate. Including facilitating discharge from acute setting and alternate settings. Provides Care Coordination throughout the continuum of care. Optimizes both the quality of care and the quality of life for the MetroPlusHealth members.
• Assist providers with achieving pay for performance goals and examine the feasibility of Value Based Payment with high volume providers for Mainstream Medicaid.
• Educate providers on medication and treatment compliance while also promoting the use of Long Acting Injectables.
• Enlist existing provider network in promoting first episode psychosis treatment.
• Documents in a comprehensive manner to ensure that all goals, interventions, and care coordination activities for each member in DCMS system, and other applicable software programs, are complaint with professional standards and regulatory guidelines.
• Evaluate housing needs appropriately and assist with housing application process. Collaborating timely with MetroPlusHeatlh internal housing team for supportive assistance.
• Contributes to MetroPlusHealth corporate goals through ongoing execution of member care plans and member goal achievement.
• Performs other appropriate Behavioral Health Departmental duties and participates in other special projects as assigned, including, but not limited to, audit review and preparation, quality improvement, community health education, facility/provider relations and marketing activities.
• Master’s Degree in healthcare or related field required
• 3-5 years of Behavioral Health (Serious Mental Illness & Substance Use Disorder) experience, preferably in a Psychiatric Hospital Inpatient and/or Outpatient experience; and
• 1-3 years of Behavioral Health Managed Care Case Management experience
• Working knowledge of NY State Health Home System and Plan of Care process
• Case Management Experience within the Integrated Collaborative Care Model Approach
• Previous history of conducting home visits to members as well as assessing them bedside during an inpatient hospitalization or at their long-term Substance Abuse Residential setting.
• Knowledge of Psyckes, E-Paces, HCS (UAS) MAPP, Microsoft Teams Video knowledge preferred.
• Medical Background & Bilingual preferred.
• Previous Quality Management liaison experience with hospitals and other large volume providers to address cost. as well as HEDIS/QARR quality performance, preferred.
• Current valid unrestricted NY State License as LCSW, LMSW, or LMHC required.
• CASAC preferred if held in addition to one of the above stated licenses
Professional Competencies
• Integrity and Trust
• Customer Service Member FIRST Focus
• Superior Technical Computer skills (Microsoft Office, DCMS, Teams Video Application)
• Exceptional Organizational and Communication Skills
• Strong interpersonal and assessment skills, the ability to remain calm and poised with challenging members who often present as in a constant state of crisis.
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
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