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New York City

    Care Manager Part Time - New York, United States - NYC Health Hospitals

    NYC Health Hospitals
    NYC Health Hospitals New York, United States

    3 weeks ago

    Default job background
    Part time
    Description


    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 to enable New Yorkers to live their healthiest life.

    Position OverviewThe Care Manager, under the direction of the Vice President of Clinical Services, is primarily responsible formanaging both simple and complex medical cases to achieve high-quality patient care outcomes and minimizeunnecessary medical expenses, through the coordination of services, both outpatient and inpatient.

    The CareManager will assist the provider in directing care to the most appropriate setting, evaluating alternative care plans, and assessing outcomes through outreach to the members.

    Job DescriptionPerforms care management including hospital admission certification, continued stay review, discharge planning, outpatient, and ancillary services review, etc., following established MetroPlusHealthUtilization Management policies, procedures, and protocols.

    Oversee the coordination and delivery of comprehensive, quality healthcare and services for all members requiring care management in a cost-effective manner.

    Interacts and obtains relevant clinical information from members' PCP and other providers; approves care that meets established criteria; and refers all other cases to the MetroPlusHealth PhysicianAdvisor/Medical Director.

    Informs member and provider of Utilization Management determinations and treatment alternatives.

    Identifies utilization trends and potential member needs by means of generating reports of encounter data,pharmacy data review, and new member health assessment forms.

    Evaluate member needs for referred cases (from providers or member self-referred).Assists all departments with the resolution of members' problems related to utilization management issues.

    Performs all Utilization Management activities in compliance with all regulatory agency requirements.
    Conducts medical record reviews as appropriate to case management functions.
    Participate in Medical Management grand rounds with the Physician Advisor.

    Performs all other duties as assignMinimum QualificationsHigh School Diploma General Equivalency Diploma (GED) required; and2-5 years' clinical experience in an acute or applicable care setting.

    UM/UR experience in managed care or hospital setting required.


    Licensure and/or Certification Required:
    New York State license as Registered Nurse, License Practical Nurse, or Physical Therapist required

    Professional Competencies:
    Integrity and TrustCustomer FocusExcellent communication, written and analytical skillsKnowledge of computer systems
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