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NYC Health + Hospitals · 19 hours ago

Health and Recovery Program Care Manager

New York, NY

Full-time

Onsite

Mid, Senior Level

$96K/yr - $96K/yr

3+ years exp

NYC Health + Hospitals is the largest public health system in the United States, committed to delivering high quality care without exception. The Health and Recovery Program Care Manager develops and communicates care plans for members with complex health needs, collaborating with various healthcare providers to ensure effective care management and follow-up services.

Health CareHome Health CareHospitalMedicalNursing and Residential Care

Responsibilities

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

Conduct Utilization Review for designated Case Management members for some diversionary levels of care. (CORE/HCBS, ACT)

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 HARP member. Notify physicians for any changes in member’s plan of care

Assists members and providers in accessing post-discharge aftercare related appointments. Works with inpatient facility team to identify appropriate follow-up care for CORE and HARP BH members

Responsible for outreaching members regarding adhering to 7-day follow up appointment to offer a 30-day appointment as part of HEDIS measures

Responsible for mailing discharge aftercare letters with a list of referrals to members not reached by phone

Collaborate timely follow up with assigned nurses for clinical updates to plans of care

Document IDT care coordination notes between both internal MetroPlusHealth staff and external Health Home/CMA workers

Review and Approve submitted Health Home Plans of Care and ensure that CMA’s are conducting timely annual assessments. Review and approve CORE/HCBS requests; educating CMA workers about PROS and IOP options for members who opt out of receiving CORE/HCBS

Assist providers with achieving pay for performance goals and examine the feasibility of Value Based Payment with high volume providers for HARP line of business

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

Educate providers to alternate treatment services being promoted by Health + Hospitals in lieu of Inpatient Detox

Attends and prepares for bi-Weekly Interdisciplinary Care Team (ICT) meetings which will feature newly enrolled, frequently admitted, high utilizing at risk HARP members

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

Evaluate housing needs appropriately and assist with housing application process. Collaborating timely with MetroPlusHealth internal housing team for supportive assistance

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. Identifies members appropriate for specialty programs

Documents in a comprehensive manner to ensure that all goals, interventions, and care coordination activities for each member in DCMS (EMR) system, and other applicable software programs, are complaint with professional standards and regulatory guidelines

Contributes to MetroPlusHealth corporate goals through ongoing execution of member care plans and member goal achievement

Performs other appropriate HARP Behavioral Health 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

Qualification

Behavioral Health ExperienceCase Management ExperienceUtilization ManagementLCSW LicenseChronic Condition ManagementMicrosoft TeamsAssessment SkillsBilingualInterpersonal SkillsCommunication SkillsOrganizational Skills

Required

Master's Degree required

Overall, 3-5 years of Behavioral Health (Serious Mental Illness & Substance Use Disorder) experience in a managed care and or in a Psychiatric Hospital Inpatient and/or Outpatient experience with both case and utilization management

Field based Case Management Experience within the Integrated Collaborative Care Model Approach

Experience with chronic condition management, particularly Diabetes, HIV, Heart Disease

Pharmacy, Psyckes, E-Paces, HCS (UAS) MAPP, CORE/HCBS, Microsoft Teams Video knowledge

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

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

Current valid unrestricted NY State License as LCSW, LMSW, LMHC

Preferred

One-year HARP experience 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