Healthfirst
Overview
The Care Manager plans and manages behavioral and/or physical care with members and works collaboratively with them, their supports, providers, and health care team members. The Care Manager applies care management principles when engaging members to coordinate health care services, address barriers, and improve health outcomes. The Care Manager is assigned to a specific product line such as CompleteCare, SNP, Medicaid/Medicare, PHSP, HARP, etc. 100% remote.
Responsibilities Advocates, informs, and educates beneficiaries on services, self-management techniques, and health benefits.
Conducts assessments to identify barriers and opportunities for intervention.
Develops care plans aligned with the physician’s treatment plans and recommends interventions that align with goals.
Generates referrals to providers, community-based resources, and other services to support goal achievement and health outcomes.
Liaises between doctors, social workers, discharge planners, and community-based providers to ensure coordinated care.
Coordinates and facilitates with the multi-disciplinary health care team to ensure care plan goals are person-centered and maximize outcomes.
Assists in identifying opportunities for alternative care options based on member needs and assessments.
Evaluates service authorizations for alignment with the member’s care and physician treatment plan.
Contributes to corporate goals through ongoing execution of member care plans and goal achievement.
Documents all encounters in the appropriate system, follows up as needed, and updates care plans as appropriate.
Occasional overtime as necessary.
Additional duties as assigned.
Minimum Qualifications For Medical Care Management:
NYS RN or
LCSW or LMSW (any state)
For PEDS positions only: 1 year of pediatric clinical field experience and/or experience with families and child-serving systems, including child welfare and/or medically fragile/developmentally disabled populations
For Behavioral Health (BH) Care Management:
NYS RN or
LCSW, LMSW, LMFT, LMHC, LPC, licensed psychologist (any state)
3 years of work experience in a mental/behavioral health or addictions setting
For BH PEDS positions only: 1 year of pediatric clinical field experience and/or experience with families and child-serving systems, including child welfare and/or medically fragile/developmentally disabled populations
Preferred Qualifications Strong interpersonal and assessment skills, especially the ability to relate well with seniors, their families, and community care providers, with the ability to handle rapidly changing situations.
Fluency in Spanish, Korean, Mandarin, or Cantonese.
Knowledge and experience with current community health practices for frail adults and cognitively impaired seniors.
Experience managing member information in a shared network environment using paperless databases and archival systems.
Experience with the relevant product line and relevant care management work experience.
Ability to manage large caseloads and work effectively in a fast-paced environment.
Proficient in navigating the Internet and multiple electronic documentation systems.
Experience using Microsoft Excel with ability to edit, search, sort, filter, and work with PHI systems.
Hiring Range Greater New York City Area (NY, NJ, CT residents): $81,099 - $116,480
All Other Locations (within approved locations): $71,594 - $106,080
As a candidate for this position, salary and related elements of compensation are contingent upon work experience, education, licenses and certifications, and other factors Healthfirst deems pertinent to the hiring decision. Healthfirst offers a full range of benefits subject to eligibility requirements.
Job Details Seniority level: Not Applicable
Employment type: Full-time
Job function: Health Care Provider
Industries: Hospitals and Health Care
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The Care Manager plans and manages behavioral and/or physical care with members and works collaboratively with them, their supports, providers, and health care team members. The Care Manager applies care management principles when engaging members to coordinate health care services, address barriers, and improve health outcomes. The Care Manager is assigned to a specific product line such as CompleteCare, SNP, Medicaid/Medicare, PHSP, HARP, etc. 100% remote.
Responsibilities Advocates, informs, and educates beneficiaries on services, self-management techniques, and health benefits.
Conducts assessments to identify barriers and opportunities for intervention.
Develops care plans aligned with the physician’s treatment plans and recommends interventions that align with goals.
Generates referrals to providers, community-based resources, and other services to support goal achievement and health outcomes.
Liaises between doctors, social workers, discharge planners, and community-based providers to ensure coordinated care.
Coordinates and facilitates with the multi-disciplinary health care team to ensure care plan goals are person-centered and maximize outcomes.
Assists in identifying opportunities for alternative care options based on member needs and assessments.
Evaluates service authorizations for alignment with the member’s care and physician treatment plan.
Contributes to corporate goals through ongoing execution of member care plans and goal achievement.
Documents all encounters in the appropriate system, follows up as needed, and updates care plans as appropriate.
Occasional overtime as necessary.
Additional duties as assigned.
Minimum Qualifications For Medical Care Management:
NYS RN or
LCSW or LMSW (any state)
For PEDS positions only: 1 year of pediatric clinical field experience and/or experience with families and child-serving systems, including child welfare and/or medically fragile/developmentally disabled populations
For Behavioral Health (BH) Care Management:
NYS RN or
LCSW, LMSW, LMFT, LMHC, LPC, licensed psychologist (any state)
3 years of work experience in a mental/behavioral health or addictions setting
For BH PEDS positions only: 1 year of pediatric clinical field experience and/or experience with families and child-serving systems, including child welfare and/or medically fragile/developmentally disabled populations
Preferred Qualifications Strong interpersonal and assessment skills, especially the ability to relate well with seniors, their families, and community care providers, with the ability to handle rapidly changing situations.
Fluency in Spanish, Korean, Mandarin, or Cantonese.
Knowledge and experience with current community health practices for frail adults and cognitively impaired seniors.
Experience managing member information in a shared network environment using paperless databases and archival systems.
Experience with the relevant product line and relevant care management work experience.
Ability to manage large caseloads and work effectively in a fast-paced environment.
Proficient in navigating the Internet and multiple electronic documentation systems.
Experience using Microsoft Excel with ability to edit, search, sort, filter, and work with PHI systems.
Hiring Range Greater New York City Area (NY, NJ, CT residents): $81,099 - $116,480
All Other Locations (within approved locations): $71,594 - $106,080
As a candidate for this position, salary and related elements of compensation are contingent upon work experience, education, licenses and certifications, and other factors Healthfirst deems pertinent to the hiring decision. Healthfirst offers a full range of benefits subject to eligibility requirements.
Job Details Seniority level: Not Applicable
Employment type: Full-time
Job function: Health Care Provider
Industries: Hospitals and Health Care
#J-18808-Ljbffr