Care Manager Case Management - New York, NY, United States - MetroPlus

Description

Care.

MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. About NYC Health + Hospitals

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 30 years, MetroPlusHealth has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.

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.

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 outcomes evaluated.

Address member's 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 member, caregivers, and health care providers, integrating concepts of cultural sensitivity and privacy practices
Ensure plans of care have individualized goals and interventions
Communicate plan of care to Primary Care Physician
Address gaps in care with the member and provider.
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 member 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.

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
Bachelor's Degree required
Minimum 2 years' prior experience in a health care setting, Care Management, or Managed Care setting required
Ability to proficiently read and interpret medical records, claims data, pharmacy, lab reports and prescriptions required

If needed, ability to travel within the MetroPlusHealth service area to participate in facility visits, community events, home visits or other community meetings, including conferences.

Proficiency with computers navigating in multiple systems and web- based applications.
Time management and organizational skills
Ability to prioritize and manage changing priorities under pressure
Must know how to use Microsoft Office applications including Word, Excel, and PowerPoint and Outlook.