MetroPlus Health Plan
Overview
Health and Recovery Plan (HARP) Care Manager Job Ref: 127456 | Category: Utilization Review and Case Management | Department: BEHAVIORAL HEALTH HARP | Location: 50 Water Street, 7th Floor, New York, NY 10004 Job Type: Regular | Employment Type: Full-Time | Hire In Rate: $95,000.00 | Salary Range: $95,000.00 MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. If you have compassion and a collaborative spirit, work with us to provide high-quality care. Responsibilities
Clinically assess members for acute behavioral and physical health needs; generate referrals to providers, community-based resources, and appropriate services to support goal achievement. Conduct Utilization Review for designated Case Management members for certain diversionary levels of care (CORE/HCBS, ACT). Meet with members in homes, shelters, other residential settings, community agencies, hospital inpatient units, and day programs as needed. Conduct initial and ongoing Behavioral Health clinical assessments. Develop formal plans of care for all services needed for the HARP member; notify physicians of changes to the plan of care. Assist members and providers in accessing post-discharge aftercare appointments; coordinate with inpatient facility teams to identify appropriate follow-up care for CORE and HARP BH members. Outreach to ensure 7-day follow-up and schedule 30-day appointments as part of HEDIS measures; mail discharge aftercare letters with referrals when phone outreach is unsuccessful. Collaborate with assigned nurses for clinical updates to care plans. Document IDT care coordination notes in DCMS (EMR) and other applicable systems; ensure regulatory compliance. Review and approve Health Home Plans of Care; ensure CMAs conduct timely annual assessments; review CORE/HCBS requests and educate CMA workers about PROS and IOP options. Support providers in achieving pay-for-performance goals and evaluate feasibility of Value Based Payment with high-volume providers for HARP. Educate providers on medication and treatment compliance; promote use of Long Acting Injectables where appropriate. Engage providers to promote first-episode psychosis treatment; participate in bi-weekly Interdisciplinary Care Team (ICT) meetings with newly enrolled and high-utilizing members. Coordinate delivery of comprehensive, quality healthcare and services for all members requiring care management in a cost-effective manner; assess housing needs and assist with housing applications in collaboration with the internal housing team. Facilitate discharge coordination from acute or alternative settings and provide care coordination throughout the continuum of care. Identify members for specialty programs and promote overall quality of care and quality of life. Document goals, interventions, and care coordination activities in DCMS (EMR) and other software; ensure professional standards and regulatory guidelines compliance. Contribute to MetroPlusHealth corporate goals through ongoing execution of member care plans and goal attainment; participate in special projects as assigned (e.g., audits, quality improvement, education, relations, and marketing). Minimum Qualifications
Master’s Degree required 3-5 years of Behavioral Health experience (Serious Mental Illness & Substance Use Disorder) in managed care or psychiatric hospital inpatient/outpatient settings with case and utilization management One-year HARP experience preferred Field-based Case Management experience within the Integrated Collaborative Care Model Experience with chronic condition management (e.g., Diabetes, HIV, Heart Disease) Pharmacy, Psyckes, E-Paces, HCS (UAS) MAPP, CORE/HCBS, Microsoft Teams knowledge Strong interpersonal and assessment skills; ability to stay calm with high-crisis-volume members Experience conducting home visits and bedside assessments in inpatient or residential settings Medical background and bilingual preferred Quality Management liaison experience with hospitals/providers; familiarity with HEDIS/QARR preferred Licensure and/or Certification
Current valid unrestricted NY State License as LCSW, LMSW, or LMHC Professional Competencies
Integrity and Trust Teamwork and Problem-Solving Customer Service with a Member-FIRST focus Strong technical skills (Microsoft Office, DCMS, Teams) Clear and concise written and oral communication Exceptional organizational skills
#J-18808-Ljbffr
Health and Recovery Plan (HARP) Care Manager Job Ref: 127456 | Category: Utilization Review and Case Management | Department: BEHAVIORAL HEALTH HARP | Location: 50 Water Street, 7th Floor, New York, NY 10004 Job Type: Regular | Employment Type: Full-Time | Hire In Rate: $95,000.00 | Salary Range: $95,000.00 MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. If you have compassion and a collaborative spirit, work with us to provide high-quality care. Responsibilities
Clinically assess members for acute behavioral and physical health needs; generate referrals to providers, community-based resources, and appropriate services to support goal achievement. Conduct Utilization Review for designated Case Management members for certain diversionary levels of care (CORE/HCBS, ACT). Meet with members in homes, shelters, other residential settings, community agencies, hospital inpatient units, and day programs as needed. Conduct initial and ongoing Behavioral Health clinical assessments. Develop formal plans of care for all services needed for the HARP member; notify physicians of changes to the plan of care. Assist members and providers in accessing post-discharge aftercare appointments; coordinate with inpatient facility teams to identify appropriate follow-up care for CORE and HARP BH members. Outreach to ensure 7-day follow-up and schedule 30-day appointments as part of HEDIS measures; mail discharge aftercare letters with referrals when phone outreach is unsuccessful. Collaborate with assigned nurses for clinical updates to care plans. Document IDT care coordination notes in DCMS (EMR) and other applicable systems; ensure regulatory compliance. Review and approve Health Home Plans of Care; ensure CMAs conduct timely annual assessments; review CORE/HCBS requests and educate CMA workers about PROS and IOP options. Support providers in achieving pay-for-performance goals and evaluate feasibility of Value Based Payment with high-volume providers for HARP. Educate providers on medication and treatment compliance; promote use of Long Acting Injectables where appropriate. Engage providers to promote first-episode psychosis treatment; participate in bi-weekly Interdisciplinary Care Team (ICT) meetings with newly enrolled and high-utilizing members. Coordinate delivery of comprehensive, quality healthcare and services for all members requiring care management in a cost-effective manner; assess housing needs and assist with housing applications in collaboration with the internal housing team. Facilitate discharge coordination from acute or alternative settings and provide care coordination throughout the continuum of care. Identify members for specialty programs and promote overall quality of care and quality of life. Document goals, interventions, and care coordination activities in DCMS (EMR) and other software; ensure professional standards and regulatory guidelines compliance. Contribute to MetroPlusHealth corporate goals through ongoing execution of member care plans and goal attainment; participate in special projects as assigned (e.g., audits, quality improvement, education, relations, and marketing). Minimum Qualifications
Master’s Degree required 3-5 years of Behavioral Health experience (Serious Mental Illness & Substance Use Disorder) in managed care or psychiatric hospital inpatient/outpatient settings with case and utilization management One-year HARP experience preferred Field-based Case Management experience within the Integrated Collaborative Care Model Experience with chronic condition management (e.g., Diabetes, HIV, Heart Disease) Pharmacy, Psyckes, E-Paces, HCS (UAS) MAPP, CORE/HCBS, Microsoft Teams knowledge Strong interpersonal and assessment skills; ability to stay calm with high-crisis-volume members Experience conducting home visits and bedside assessments in inpatient or residential settings Medical background and bilingual preferred Quality Management liaison experience with hospitals/providers; familiarity with HEDIS/QARR preferred Licensure and/or Certification
Current valid unrestricted NY State License as LCSW, LMSW, or LMHC Professional Competencies
Integrity and Trust Teamwork and Problem-Solving Customer Service with a Member-FIRST focus Strong technical skills (Microsoft Office, DCMS, Teams) Clear and concise written and oral communication Exceptional organizational skills
#J-18808-Ljbffr