MetroPlusHealth
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Care Manager
role at
MetroPlusHealth 2 days ago Be among the first 25 applicants Join to apply for the
Care Manager
role at
MetroPlusHealth This range is provided by MetroPlusHealth. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more. Base pay range
$108,815.00/yr - $108,815.00/yr 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 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.
Position Overview
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.
The nurse Care Manager (CM) is responsible for reviewing, and approving Plans of Care, CANS-NY assessments, and UM review for HCBS services.The CM is also responsible for care management for medically fragile children and supporting the coordination of services related to inpatient, homecare, specialty medications, and DME according to UM requirements set forth by the “office of Health Insurance Programs Principles for Medically Fragile Children.The CM works with Health Home Coordinators, community providers, and LDSS/VCFA to ensure proper access, level of care, level of need and continuation of care for Medically Fragile and Care at Home children.
Work Shifts
9:00 A.M – 5:00 P.M
Duties & Responsibilities
Coordinates with Health Home Coordinators and LDSS/VFCA Care Managers to ensure that patient comprehensive treatment needs are met. Coordinates member’s service needs with community agencies. Provide education and coaching to members’ family. Conducts follow up quarterly assessment calls to Health Home Coordinators. Provide clinical guidance and support to assist members with achieving their goals. Have extensive knowledge of community resources/services. Prepares for and participates in all clinical rounds. Interacts with physicians and other members of the Providers’ Clinical Teams for discharge planning and required DME. Coordinates with UM team to determine appropriate level of care. Consults with Clinical Peer Reviewers when requests for services do not meet medical necessity criteria. Interacts with Clinical Peer Reviewers to discuss clinical/authorization questions, alternative treatment options and concerns regarding specific cases. Provides information to members’ families, Health Home coordinators, LDSS/VFCA, clinical and HCBS providers regarding medical benefits. Provides telephone triage and crisis intervention to callers and, when necessary, assists with ensuring members have access to local services and resources. Recognizes quality of care issues and reports them appropriately through internal and external processes. Perform other duties as assigned by Medical Director for Medically Fragile Children, Senior Director of Children’s Special Services, and the Director of Children’s
Minimum Qualifications
A minimum of a bachelor’s degree A minimum of two years’ clinical experience in an acute care setting Experience using InterQual Guidelines required. Knowledge of medical care and HCBS services needed by medically fragile children.
Licensure And/or Certification Required
A valid NYS RN license.
Professional Competencies
Clinical skills and subject matter knowledge. Must be able to learn and master UM/CM MetroPlusHealth systems and procedures. Customer Service Oral and written communication skills
Benefits
NYC Health and Hospitals offers a competitive benefits package that includes:
Comprehensive Health Benefits for employees hired to work 20+ hrs. per week Retirement Savings and Pension Plans Paid Holidays and Vacation in accordance with employees' Collectively bargained contracts Loan Forgiveness Programs for eligible employees College tuition discounts and professional development opportunities College Savings Program Union Benefits for eligible titles Multiple employee discounts programs Commuter Benefits Programs
Seniority level
Seniority level Entry level Employment type
Employment type Full-time Job function
Job function Health Care Provider Industries Hospitals and Health Care Referrals increase your chances of interviewing at MetroPlusHealth by 2x Sign in to set job alerts for “Care Manager” roles.
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Care Manager
role at
MetroPlusHealth 2 days ago Be among the first 25 applicants Join to apply for the
Care Manager
role at
MetroPlusHealth This range is provided by MetroPlusHealth. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more. Base pay range
$108,815.00/yr - $108,815.00/yr 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 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.
Position Overview
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.
The nurse Care Manager (CM) is responsible for reviewing, and approving Plans of Care, CANS-NY assessments, and UM review for HCBS services.The CM is also responsible for care management for medically fragile children and supporting the coordination of services related to inpatient, homecare, specialty medications, and DME according to UM requirements set forth by the “office of Health Insurance Programs Principles for Medically Fragile Children.The CM works with Health Home Coordinators, community providers, and LDSS/VCFA to ensure proper access, level of care, level of need and continuation of care for Medically Fragile and Care at Home children.
Work Shifts
9:00 A.M – 5:00 P.M
Duties & Responsibilities
Coordinates with Health Home Coordinators and LDSS/VFCA Care Managers to ensure that patient comprehensive treatment needs are met. Coordinates member’s service needs with community agencies. Provide education and coaching to members’ family. Conducts follow up quarterly assessment calls to Health Home Coordinators. Provide clinical guidance and support to assist members with achieving their goals. Have extensive knowledge of community resources/services. Prepares for and participates in all clinical rounds. Interacts with physicians and other members of the Providers’ Clinical Teams for discharge planning and required DME. Coordinates with UM team to determine appropriate level of care. Consults with Clinical Peer Reviewers when requests for services do not meet medical necessity criteria. Interacts with Clinical Peer Reviewers to discuss clinical/authorization questions, alternative treatment options and concerns regarding specific cases. Provides information to members’ families, Health Home coordinators, LDSS/VFCA, clinical and HCBS providers regarding medical benefits. Provides telephone triage and crisis intervention to callers and, when necessary, assists with ensuring members have access to local services and resources. Recognizes quality of care issues and reports them appropriately through internal and external processes. Perform other duties as assigned by Medical Director for Medically Fragile Children, Senior Director of Children’s Special Services, and the Director of Children’s
Minimum Qualifications
A minimum of a bachelor’s degree A minimum of two years’ clinical experience in an acute care setting Experience using InterQual Guidelines required. Knowledge of medical care and HCBS services needed by medically fragile children.
Licensure And/or Certification Required
A valid NYS RN license.
Professional Competencies
Clinical skills and subject matter knowledge. Must be able to learn and master UM/CM MetroPlusHealth systems and procedures. Customer Service Oral and written communication skills
Benefits
NYC Health and Hospitals offers a competitive benefits package that includes:
Comprehensive Health Benefits for employees hired to work 20+ hrs. per week Retirement Savings and Pension Plans Paid Holidays and Vacation in accordance with employees' Collectively bargained contracts Loan Forgiveness Programs for eligible employees College tuition discounts and professional development opportunities College Savings Program Union Benefits for eligible titles Multiple employee discounts programs Commuter Benefits Programs
Seniority level
Seniority level Entry level Employment type
Employment type Full-time Job function
Job function Health Care Provider Industries Hospitals and Health Care Referrals increase your chances of interviewing at MetroPlusHealth by 2x Sign in to set job alerts for “Care Manager” roles.
Clinic Manager, Bureau of Public Health Clinics
New York, NY $100,000.00-$160,000.00 3 weeks ago Englewood, NJ $70,000.00-$88,000.00 2 months ago Franklin Square, NY $65,000.00-$75,000.00 1 day ago Bronx, NY $60,000.00-$75,000.00 1 year ago New York, NY $108,815.00-$108,815.00 6 days ago New York, NY $108,815.00-$108,815.00 6 days ago Health Home Care Manager – Full-Time (New York State)
Practice Manager - Multispecialty Practice - Days - Westchester Medical Group
New York, NY $84,500.00-$123,500.00 1 day ago New York, NY $83,000.00-$83,000.00 6 days ago Brooklyn, NY $10,000.00-$140,000.00 3 days ago Livingston, NJ $60,000.00-$65,000.00 3 weeks ago Brooklyn, NY $96,000.00-$105,000.00 3 weeks ago New York, NY $100,000.00-$119,000.00 5 days ago Care Manager of Health Home Care Management
Full Time Residence Manager - Muller Residence
New York, NY $250,000.00-$280,000.00 5 days ago Bronx, NY $10,000.00-$140,000.00 1 week ago Manhattan, NY $80,000.00-$85,000.00 2 weeks ago 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