MetroPlusHealth · 10 hours ago
Quality Management Clinical Outreach Specialist
New York, NY
Full-time
Hybrid
Mid, Senior Level
$79K/yr - $89K/yr
3+ years expMetroPlusHealth is seeking a Quality Management Clinical Outreach Specialist responsible for telephonically outreaching members recently discharged from various care settings. The role involves assessing members' current states, reviewing discharge plans, and connecting them with appropriate aftercare services while collaborating with Behavioral Health Case Management teams.
Financial ServicesHealth CareHealth InsuranceInsuranceLife Insurance
Responsibilities
Assists members in accessing post-discharge aftercare related appointments/rescheduling new appointments
Interfaces with members and Behavioral Health or Medical Case Management staff to coordinate aftercare activities
Delivers crisis and emotional support when needed during telephonic outreaches. Ability to de-escalate crisis/utilize crisis intervention techniques and motivational interviewing before bridging to proper crisis services
Meets the daily expected call volume and number of bridge visits. Self-monitors productivity and accepts supervision towards a high level of member care
Maintains accurate and complete documentation of required information in compliance with risk management and regulatory requirements
Shares observations and provides feedback regarding workflow to ensure continuous quality improvement
Performs other departmental duties and participates in special/ad-hoc projects as assigned
Qualification
Required
Master's Degree required
Minimum 3 years of Behavioral Health (Serious Mental Illness & Substance Use Disorder) experience in managed care setting
Minimum of 3 years' post licensing experience working directly with consumers towards their recovery
Understanding of Medication Assisted Treatment process
Pharmacy, Psyckes, E-Paces, HCS (UAS) MAPP knowledge
Working knowledge of current DSM Manual and understanding of Behavioral Health diagnosis
Knowledge of quality improvement methodologies, i.e., PDSA, Six Sigma
Strong technical skills (Microsoft Office, specifically MS Excel and MS Access; ability to navigate multiple computer programs and applications)
Valid New York State license and current registration to practice as Licensed Clinical Social Worker (LCSW), Licensed Master Social Worker (LMSW), or Licensed Mental Health Counselor (LMHC)
Self-motivated and able to work in a fast-paced, dynamic work environment
Possess strong attention to detail and technical abilities
Organized and able to meet deadlines
Demonstrate strong communication skills
Integrity and Trust
Customer Focus
Demonstrated ability to communicate effectively, problem solve and work effectively with people
Clear and concise written/oral communications
Exceptional time management and organizational skills
Ability to function in a fast-paced, dynamic work environment
Strong interpersonal skills, the ability to remain calm and poised with challenging situations
Self-starter who is able to perform tasks at a high level with minimal supervision
Ability to work evenings and weekends as needed to meet department goals
Preferred
Knowledge HEDIS/QARR strongly preferred
Bilingual (English/Spanish) strongly preferred
Company
MetroPlusHealth
MetroPlusHealth provides health insurance to individuals, families, and small businesses.
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
Julie Myers
Deputy Chief Medical Officer
Laura Santella-Saccone
Chief Marketing & Brand Officer
Recent News
2025-07-17
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