Job Description

Care Manager LMSW

Job Ref: 107441
Category: Utilization Review and Case Management
Department: CASE MANAGEMENT PROGRAM
Location: 50 Water Street, 7th Floor, New York, NY 10004
Job Type: Regular
Employment Type: Full-Time
Hire In Rate: $85,000.00
Salary Range: $85,000.00 - $85,000.00

Empower. Unite. Care.

MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day.

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.

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. The Care Manager is expected to assess and evaluate member’s needs, be a creative, efficient, and resourceful problem solver. The Care Manager serves as member’s advocate and accompanies the member throughout their care journey. 

The Care Manager is monitored and assessed based on value added to improved health status of member. That includes but not limited to their disease management physical and behavioral, medication adherence, and utilization of emergency services, hospitalizations, and avoidable complications. The Care Manager’s primary role is to support members in need and problem solve issues in a beneficial manner for the member and Plan. The support is comprehensive and includes clinical, social, financial, environmental and safety aspects.

 

Job Description

Physically meet the members where they are to gain deep understanding of their situation and needs

Problem solve member’s problems and needs: clinical, psychosocial, financial, environmental

Provide services to members of varying age, clinical scenario, culture, financial means, social support, and motivation

Engage members in a collaborative relationship, empowering them to manage their physical, psychosocial and environmental health to improve and maintain lifelong well being

Assess risks and gaps in care 

Maximize member’s access to available resources 

Prepare member-oriented plan of care with member, caregivers, and health care providers, integrating concepts of cultural sensitivity and privacy practices 

Communicate plan of care to Primary Care Physician initially and no less than monthly with updates

Ensure member caregiver understanding as it relates to language barriers, stress reaction or cognitive limitations/barriers using verbal and nonverbal techniques

Train member on relevant chronic diseases, preventive care, medication management (medication adherence), home safety, etc

Provide Complex care management including but not limited to; insuring 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

Develop collaborative relationships with clinical providers and facility staff

Employ critical thinking and judgment when dealing with unplanned issues

Ability to use data as a tool in tracking and trending outcomes and clinical information

Maintain accurate, comprehensive, and current clinical and non-clinical documents

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 Team Lead and Manager 

Minimum Qualifications

Master's Degree Required 

LMSW/LCSW with current NYS license 

Minimum 3 years’ in prior experience in Case Management in a health care and/or Managed Care setting strongly preferred

Proficiency with computers navigating in multiple systems and web-based applications

Ability to proficiently read and interpret medical records, claims data, pharmacy and lab reports, and prescriptions required

Ability to work closely with member and caregiver 

Professional Competencies 

Integrity and trust 

Customer focus 

Functional/Technical skills 

Written/oral communication 

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 form effective working relationships with a wide range of individuals.

#MHP50

#LI-Hybrid 

Job Tags

Similar Jobs