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Care Manager (RN (Medicaid)

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MetroPlus Health PlanNew York, NY
Full-time
  • As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlus' 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 Overview: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.
  • This is accomplished through engagement and understanding of the member's needs, environment, providers, support system and optimization of services available to them.
  • 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
  • Participate in interdisciplinary rounds
  • 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
  • Address members social determinants of health issues
  • Link members to available resources
  • 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
  • Advocate for members by assisting them to address challenges and make informed choices regarding clinical status and treatment options
  • Employ critical thinking and judgment when dealing with unplanned issues
  • Maintain knowledge of Chronic Conditions and use job aids as a guidance
  • 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
  • Other duties as assigned by ManagerMinimum Qualifications
  • Background: Registered Nurse, Bachelor's Degree in Nursing required
  • An equivalent combination of training, educational background, and experience in related fields such as hospital, home care, ambulatory setting and educational disciplines.
  • Prior experience in Care Management in a health care and/or Managed Care setting preferred
  • Proficiency with computers navigating in multiple systems and web- based applications
  • Confident, autonomous, solution driven, detail oriented, high standards of excellence, nonjudgmental, diplomatic, resourceful, intuitive, dedicated, resilient and proactive
  • Strong verbal and written communication skills including motivational coaching, influencing and negotiation abilities
  • Time management and organizational skills
  • Strong problem-solving 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.
  • Ability to proficiently read and interpret medical records, claims data, pharmacy, lab reports and prescriptions required
  • If needed, ability to travel within the MetroPlus service area to participate in facility visits, community events, home visits or other community meetings, including conferences.
  • Registered Nurse or LMSW/LCSW with current NYS license
  • Associated topics: ambulatory, care, coronary, hospice, infusion, intensive, neonatal, nurse clinical, recovery, unit

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