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 and coordinating their health care services to provide an excellent member experience, 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. This position is 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 that align with the physician’s treatment plans and recommends interventions that align with proposed goals.
Generates referrals to providers, community-based resources, and appropriate services to assist in goal achievement and maintenance of health outcomes.
Liaises between doctors, social workers, discharge planners, and community-based service providers to ensure coordinated care and address care needs.
Coordinates and facilitates with the multi-disciplinary health care team to ensure care plan goals are person-centered and maximize member health outcomes.
Assists in identifying opportunities for alternative care options based on member needs and assessments.
Evaluates service authorizations to ensure 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 with providers, members, and vendors in the appropriate system in accordance with documentation procedures; follows up as needed and updates care plans accordingly.
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 relating 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 database modules and archival systems.
Experience and knowledge of the relevant product line.
Relevant work experience preferably as a Care Manager.
Ability to manage large caseloads and work effectively in a fast-paced environment.
Proficient with navigating the Internet and multi-tasking with multiple electronic documentation systems.
Experience using Microsoft Excel with the ability to edit, search, sort/filter, and other Microsoft and 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 will depend on work experience, education, licenses and certifications, and other factors Healthfirst deems pertinent to the hiring decision.
In addition to salary, Healthfirst offers a full range of benefits such as medical, dental, and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (benefits subject to eligibility). The hiring range is defined as the lowest and highest salaries Healthfirst would pay in good faith for a new hire or for a promotion/transfer.
Job Details
Seniority level: Not Applicable
Employment type: Full-time
Job function: Health Care Provider
Industry: Hospitals and Health Care
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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 that align with the physician’s treatment plans and recommends interventions that align with proposed goals.
Generates referrals to providers, community-based resources, and appropriate services to assist in goal achievement and maintenance of health outcomes.
Liaises between doctors, social workers, discharge planners, and community-based service providers to ensure coordinated care and address care needs.
Coordinates and facilitates with the multi-disciplinary health care team to ensure care plan goals are person-centered and maximize member health outcomes.
Assists in identifying opportunities for alternative care options based on member needs and assessments.
Evaluates service authorizations to ensure 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 with providers, members, and vendors in the appropriate system in accordance with documentation procedures; follows up as needed and updates care plans accordingly.
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 relating 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 database modules and archival systems.
Experience and knowledge of the relevant product line.
Relevant work experience preferably as a Care Manager.
Ability to manage large caseloads and work effectively in a fast-paced environment.
Proficient with navigating the Internet and multi-tasking with multiple electronic documentation systems.
Experience using Microsoft Excel with the ability to edit, search, sort/filter, and other Microsoft and 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 will depend on work experience, education, licenses and certifications, and other factors Healthfirst deems pertinent to the hiring decision.
In addition to salary, Healthfirst offers a full range of benefits such as medical, dental, and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (benefits subject to eligibility). The hiring range is defined as the lowest and highest salaries Healthfirst would pay in good faith for a new hire or for a promotion/transfer.
Job Details
Seniority level: Not Applicable
Employment type: Full-time
Job function: Health Care Provider
Industry: Hospitals and Health Care
Notes We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.
#J-18808-Ljbffr