MetroPlus Health Plan
Overview
HARP Care Manager Job Ref:
126944 Category:
Behavioral Health Department:
BEHAVIORAL HEALTH HARP Location:
50 Water Street, 7th Floor, New York, NY 10004 Job Type:
Regular Employment Type:
Full-Time Hire In Rate:
$95,800.00 Salary Range:
$95,800.00 - $95,800.00
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 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.
At NYC Health + Hospitals, our mission is to deliver high quality care health services, without exception. Every employee takes a person-centered approach that exemplifies the ICARE values (Integrity, Compassion, Accountability, Respect, and Excellence) through empathic communication and partnerships between all persons.
Position Overview:
Empower. Unite. Care.
Role:
The HARP Care Manager develops, facilitates, and communicates a plan of care in partnership with the member, their assigned Health Home, primary caregiver, the primary and attending physicians, and various Behavioral Health and/or Substance Use Disorder providers. In partnership with these parties, the HARP Care Manager assesses, plans, facilitates, and advocates for options and services to meet a HARP member's complex health needs through communication and available resources. The HARP Care Manager is responsible for scheduling aftercare follow-up for members discharging from an acute behavioral health inpatient setting. This position ensures that members have a scheduled appointment in place, makes follow-up and reminder calls to members, and follows up with providers to ensure member compliance with aftercare. Most case management activities will be performed in the field via community and facilities outreach.
Duties & Responsibilities
Clinically assess members for acute behavioral and physical health needs.
Generate referrals to providers, community-based resources, and appropriate services and other resources to assist in goal achievement.
Conduct Utilization Review for designated Case Management members for some diversionary levels of care (CORE/HCBS, ACT).
Meet with members in their homes, shelters, other residential settings, at community agencies, hospital inpatient units and/or day hospital programs.
Conduct initial and ongoing Behavioral Health clinical assessments.
Develop a formal plan of care for all services needed for the HARP member. Notify physicians of any changes in the member's plan of care.
Assist members and providers in accessing post-discharge aftercare related appointments. Work with inpatient facility team to identify appropriate follow-up care for CORE and HARP BH members.
Outreach to members regarding adherence to 7-day follow-up appointments to offer a 30-day appointment as part of HEDIS measures.
Mail discharge aftercare letters with a list of referrals to members not reached by phone.
Collaborate on timely follow-up with assigned nurses for clinical updates to plans of care.
Document IDT care coordination notes between internal MetroPlusHealth staff and external Health Home/CMA workers.
Review and approve submitted Health Home Plans of Care and ensure that CMAs are conducting timely annual assessments. Review and approve CORE/HCBS requests; educate CMA workers about PROS and IOP options for members who opt out of receiving CORE/HCBS.
Assist providers with achieving pay-for-performance goals and examine the feasibility of Value Based Payment with high-volume providers for the HARP line of business.
Educate providers on medication and treatment compliance while promoting the use of Long Acting Injectables.
Promote first episode psychosis treatment within the provider network.
Educate providers on alternative treatment services promoted by Health + Hospitals in lieu of Inpatient Detox.
Attend and prepare for bi-Weekly Interdisciplinary Care Team (ICT) meetings for newly enrolled, frequently admitted, high-utilizing at-risk HARP members.
Oversee the coordination and delivery of comprehensive, quality healthcare and services for all members requiring care management in a cost-effective manner.
Evaluate housing needs and assist with housing application processes, coordinating with MetroPlusHealth housing team for supportive assistance.
Assist members with coordination of services from various settings as appropriate, including facilitating discharge from acute and alternate settings. Provide care coordination throughout the continuum of care.
Identify members appropriate for specialty programs.
Document comprehensively to ensure goals, interventions, and care coordination activities are compliant with professional standards and regulatory guidelines in the DCMS (EMR) system and other applicable software.
Contribute to corporate goals through ongoing execution of member care plans and goal achievement.
Perform other appropriate HARP Behavioral Health duties and participate in special projects as assigned (e.g., audit reviews, quality improvement, community health education, facility/provider relations, and marketing).
Minimum Qualifications
Master's Degree required
Overall, 3-5 years of Behavioral Health (Serious Mental Illness & Substance Use Disorder) experience in a managed care and/or Psychiatric Hospital Inpatient and/or Outpatient setting with case and utilization management. One-year HARP experience preferred.
Field-based Case Management Experience within the Integrated Collaborative Care Model Approach.
Experience with chronic condition management, particularly Diabetes, HIV, Heart Disease.
Pharmacy, Psyckes, E-PACES, HCS (UAS) MAPP, CORE/HCBS, Microsoft Teams Video knowledge.
Strong interpersonal and assessment skills, ability to remain calm with challenging members who may be in crisis.
History of conducting home visits and bedside assessments during inpatient hospitalization or at long-term Substance Abuse Residential settings.
Medical background and bilingual preferred.
Quality Management liaison experience with hospitals and high-volume providers for cost and HEDIS/QARR quality performance, preferred.
Current valid unrestricted NY State License as LCSW, LMSW, or LMHC.
Professional Competencies
Integrity and Trust
Teamwork and Problem-Solving Attitude
Customer Service with a Member-FIRST focus
Superior technical computer skills (Microsoft Office, DCMS, Teams)
Clear and concise written/oral communications
Exceptional organizational and communication skills
Benefits MetroPlusHealth 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 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 discount programs
Commuter benefits programs
#LI-HYBRID
#MPH-50
#J-18808-Ljbffr
HARP Care Manager Job Ref:
126944 Category:
Behavioral Health Department:
BEHAVIORAL HEALTH HARP Location:
50 Water Street, 7th Floor, New York, NY 10004 Job Type:
Regular Employment Type:
Full-Time Hire In Rate:
$95,800.00 Salary Range:
$95,800.00 - $95,800.00
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 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.
At NYC Health + Hospitals, our mission is to deliver high quality care health services, without exception. Every employee takes a person-centered approach that exemplifies the ICARE values (Integrity, Compassion, Accountability, Respect, and Excellence) through empathic communication and partnerships between all persons.
Position Overview:
Empower. Unite. Care.
Role:
The HARP Care Manager develops, facilitates, and communicates a plan of care in partnership with the member, their assigned Health Home, primary caregiver, the primary and attending physicians, and various Behavioral Health and/or Substance Use Disorder providers. In partnership with these parties, the HARP Care Manager assesses, plans, facilitates, and advocates for options and services to meet a HARP member's complex health needs through communication and available resources. The HARP Care Manager is responsible for scheduling aftercare follow-up for members discharging from an acute behavioral health inpatient setting. This position ensures that members have a scheduled appointment in place, makes follow-up and reminder calls to members, and follows up with providers to ensure member compliance with aftercare. Most case management activities will be performed in the field via community and facilities outreach.
Duties & Responsibilities
Clinically assess members for acute behavioral and physical health needs.
Generate referrals to providers, community-based resources, and appropriate services and other resources to assist in goal achievement.
Conduct Utilization Review for designated Case Management members for some diversionary levels of care (CORE/HCBS, ACT).
Meet with members in their homes, shelters, other residential settings, at community agencies, hospital inpatient units and/or day hospital programs.
Conduct initial and ongoing Behavioral Health clinical assessments.
Develop a formal plan of care for all services needed for the HARP member. Notify physicians of any changes in the member's plan of care.
Assist members and providers in accessing post-discharge aftercare related appointments. Work with inpatient facility team to identify appropriate follow-up care for CORE and HARP BH members.
Outreach to members regarding adherence to 7-day follow-up appointments to offer a 30-day appointment as part of HEDIS measures.
Mail discharge aftercare letters with a list of referrals to members not reached by phone.
Collaborate on timely follow-up with assigned nurses for clinical updates to plans of care.
Document IDT care coordination notes between internal MetroPlusHealth staff and external Health Home/CMA workers.
Review and approve submitted Health Home Plans of Care and ensure that CMAs are conducting timely annual assessments. Review and approve CORE/HCBS requests; educate CMA workers about PROS and IOP options for members who opt out of receiving CORE/HCBS.
Assist providers with achieving pay-for-performance goals and examine the feasibility of Value Based Payment with high-volume providers for the HARP line of business.
Educate providers on medication and treatment compliance while promoting the use of Long Acting Injectables.
Promote first episode psychosis treatment within the provider network.
Educate providers on alternative treatment services promoted by Health + Hospitals in lieu of Inpatient Detox.
Attend and prepare for bi-Weekly Interdisciplinary Care Team (ICT) meetings for newly enrolled, frequently admitted, high-utilizing at-risk HARP members.
Oversee the coordination and delivery of comprehensive, quality healthcare and services for all members requiring care management in a cost-effective manner.
Evaluate housing needs and assist with housing application processes, coordinating with MetroPlusHealth housing team for supportive assistance.
Assist members with coordination of services from various settings as appropriate, including facilitating discharge from acute and alternate settings. Provide care coordination throughout the continuum of care.
Identify members appropriate for specialty programs.
Document comprehensively to ensure goals, interventions, and care coordination activities are compliant with professional standards and regulatory guidelines in the DCMS (EMR) system and other applicable software.
Contribute to corporate goals through ongoing execution of member care plans and goal achievement.
Perform other appropriate HARP Behavioral Health duties and participate in special projects as assigned (e.g., audit reviews, quality improvement, community health education, facility/provider relations, and marketing).
Minimum Qualifications
Master's Degree required
Overall, 3-5 years of Behavioral Health (Serious Mental Illness & Substance Use Disorder) experience in a managed care and/or Psychiatric Hospital Inpatient and/or Outpatient setting with case and utilization management. One-year HARP experience preferred.
Field-based Case Management Experience within the Integrated Collaborative Care Model Approach.
Experience with chronic condition management, particularly Diabetes, HIV, Heart Disease.
Pharmacy, Psyckes, E-PACES, HCS (UAS) MAPP, CORE/HCBS, Microsoft Teams Video knowledge.
Strong interpersonal and assessment skills, ability to remain calm with challenging members who may be in crisis.
History of conducting home visits and bedside assessments during inpatient hospitalization or at long-term Substance Abuse Residential settings.
Medical background and bilingual preferred.
Quality Management liaison experience with hospitals and high-volume providers for cost and HEDIS/QARR quality performance, preferred.
Current valid unrestricted NY State License as LCSW, LMSW, or LMHC.
Professional Competencies
Integrity and Trust
Teamwork and Problem-Solving Attitude
Customer Service with a Member-FIRST focus
Superior technical computer skills (Microsoft Office, DCMS, Teams)
Clear and concise written/oral communications
Exceptional organizational and communication skills
Benefits MetroPlusHealth 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 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 discount programs
Commuter benefits programs
#LI-HYBRID
#MPH-50
#J-18808-Ljbffr