MetroPlus Health Plan
Job Overview
Behavioral Health Care Manager The BH 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. This position collaborates with the aforementioned parties to assess, plan, facilitate, and advocate for options and services to meet a member's behavioral health needs through communication and available resources. Location and Schedule
Location: 50 Water Street, 7th Floor, New York, NY 10004 Work Shifts
9:00 AM – 5:00 PM Duties & Responsibilities
Clinically assess members for acute behavioral and physical health needs; generate referrals to providers, community-based resources, and appropriate services to assist in goal achievement. 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 member. Notify physicians of changes in the member's plan of care and follow up with assigned nurses for clinical updates. Document IDT care coordination notes between MetroPlus Health staff and external BH providers and caregivers. Attend and prepare for bi-weekly Interdisciplinary Care Team (ICT) meetings for newly enrolled, frequently admitted, high-utilizing at-risk members. Assist members with coordinating services across settings, including facilitating discharge from acute and alternate settings; provide care coordination throughout the continuum of care to optimize quality of care and quality of life. Assist providers with pay-for-performance goals and assess the feasibility of Value Based Payment with high-volume providers for Mainstream Medicaid. Educate providers on medication and treatment compliance while promoting the use of Long Acting Injectables. Promote first-episode psychosis treatment by enlisting existing provider networks. Document comprehensively to ensure all goals, interventions, and care coordination activities are compliant with professional standards and regulatory guidelines in DCMS and other applicable systems. Evaluate housing needs and assist with the housing application process; collaborate with MetroPlus internal housing team for supportive services. Contribute to MetroPlus corporate goals through ongoing execution of member care plans and achievement of member goals. Perform other appropriate Behavioral Health Departmental duties and participate in special projects as assigned (e.g., audit reviews, quality improvement, community health education, facility/provider relations, marketing activities). Minimum Qualifications
Bachelor's Degree in healthcare or related field required. 3-5 years of Behavioral Health (Serious Mental Illness & Substance Use Disorder) experience, preferably in a Psychiatric Hospital Inpatient and/or Outpatient setting. 1-3 years of Behavioral Health Managed Care Case Management experience. Working knowledge of NY State Health Home System and Plan of Care process. Case Management Experience within the Integrated Collaborative Care Model Approach. Strong interpersonal and assessment skills; ability to remain calm with challenging members in crisis. Experience conducting home visits and bedside assessments during inpatient hospitalization or at long-term Substance Abuse Residual settings. Knowledge of Psyckes, E-Paces, HCS (UAS) MAPP; Microsoft Teams Video knowledge preferred. Medical background and bilingual preferred. Previous Quality Management liaison experience with hospitals and large-volume providers related to cost and HEDIS/QARR quality performance preferred. Licensure and/or Certification Required
Current valid unrestricted NY State License as LCSW, LMSW, or LMHC required. CASAC preferred if held in addition to one of the above licenses. Professional Competencies
Integrity and Trust Customer Service – Member FIRST Focus Superior technical computer skills (Microsoft Office, DCMS, Teams Video Application) Exceptional organizational and communication skills
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Behavioral Health Care Manager The BH 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. This position collaborates with the aforementioned parties to assess, plan, facilitate, and advocate for options and services to meet a member's behavioral health needs through communication and available resources. Location and Schedule
Location: 50 Water Street, 7th Floor, New York, NY 10004 Work Shifts
9:00 AM – 5:00 PM Duties & Responsibilities
Clinically assess members for acute behavioral and physical health needs; generate referrals to providers, community-based resources, and appropriate services to assist in goal achievement. 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 member. Notify physicians of changes in the member's plan of care and follow up with assigned nurses for clinical updates. Document IDT care coordination notes between MetroPlus Health staff and external BH providers and caregivers. Attend and prepare for bi-weekly Interdisciplinary Care Team (ICT) meetings for newly enrolled, frequently admitted, high-utilizing at-risk members. Assist members with coordinating services across settings, including facilitating discharge from acute and alternate settings; provide care coordination throughout the continuum of care to optimize quality of care and quality of life. Assist providers with pay-for-performance goals and assess the feasibility of Value Based Payment with high-volume providers for Mainstream Medicaid. Educate providers on medication and treatment compliance while promoting the use of Long Acting Injectables. Promote first-episode psychosis treatment by enlisting existing provider networks. Document comprehensively to ensure all goals, interventions, and care coordination activities are compliant with professional standards and regulatory guidelines in DCMS and other applicable systems. Evaluate housing needs and assist with the housing application process; collaborate with MetroPlus internal housing team for supportive services. Contribute to MetroPlus corporate goals through ongoing execution of member care plans and achievement of member goals. Perform other appropriate Behavioral Health Departmental duties and participate in special projects as assigned (e.g., audit reviews, quality improvement, community health education, facility/provider relations, marketing activities). Minimum Qualifications
Bachelor's Degree in healthcare or related field required. 3-5 years of Behavioral Health (Serious Mental Illness & Substance Use Disorder) experience, preferably in a Psychiatric Hospital Inpatient and/or Outpatient setting. 1-3 years of Behavioral Health Managed Care Case Management experience. Working knowledge of NY State Health Home System and Plan of Care process. Case Management Experience within the Integrated Collaborative Care Model Approach. Strong interpersonal and assessment skills; ability to remain calm with challenging members in crisis. Experience conducting home visits and bedside assessments during inpatient hospitalization or at long-term Substance Abuse Residual settings. Knowledge of Psyckes, E-Paces, HCS (UAS) MAPP; Microsoft Teams Video knowledge preferred. Medical background and bilingual preferred. Previous Quality Management liaison experience with hospitals and large-volume providers related to cost and HEDIS/QARR quality performance preferred. Licensure and/or Certification Required
Current valid unrestricted NY State License as LCSW, LMSW, or LMHC required. CASAC preferred if held in addition to one of the above licenses. Professional Competencies
Integrity and Trust Customer Service – Member FIRST Focus Superior technical computer skills (Microsoft Office, DCMS, Teams Video Application) Exceptional organizational and communication skills
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