Diversityjobs
Job Information
Job Ref:
127673 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 Salary Range:
$95,000.00 - $95,000.00
About the Organization MetroPlusHealth, a wholly‑owned subsidiary of NYC Health + Hospitals, provides health services across New York City. We focus on empowering communities and delivering quality care to patients, including managed care, Medicare, Medicaid, and other programs.
Position Overview The Health and Recovery Plan (HARP) Care Manager develops, facilitates, and communicates a plan of care with members, Health Homes, caregivers, physicians and behavioral health providers. The role assesses, plans, facilitates, and advocates for services, manages after‑care follow‑up for acute behavioral health discharges, and ensures member compliance with follow‑up appointments.
Work Shifts 9:00 am – 5:00 pm
Duties & Responsibilities
Clinically assess members for acute behavioral and physical health needs and generate referrals to providers and community resources.
Conduct utilization review for designated case‑management members at diversionary levels of care (CORE/HCBS, ACT).
Meet with members in homes, shelters, residential settings, community agencies, hospital inpatient units, and day hospital programs.
Conduct initial and ongoing behavioral health clinical assessments.
Develop formal plans of care and notify physicians of any changes.
Assist members in accessing post‑discharge aftercare appointments and coordinate with inpatient teams for suitable follow‑up.
Outreach members regarding 7‑day follow‑up appointments and offer 30‑day appointments as part of HEDIS measures.
Mail discharge aftercare letters with referral lists to members not reached by phone.
Collaborate with assigned nurses for timely clinical updates to plans of care.
Document IDT care‑coordination notes with internal staff and external Health Home/CMA workers.
Review and approve submitted Health Home plans of care and CORE/HCBS requests; educate CMA workers on PROS and IOP options.
Assist providers in achieving pay‑for‑performance goals and explore value‑based payment feasibility.
Educate providers on medication adherence and use of long‑acting injectables.
Promote first‑episode psychosis treatment within provider network.
Advise providers on alternative treatment services in place of inpatient detox.
Attend and prepare for bi‑weekly interdisciplinary care team meetings for high‑utilizing HARP members.
Oversee delivery of comprehensive, cost‑effective healthcare for all members.
Evaluate housing needs and assist with housing applications, collaborating with internal housing team.
Coordinate services across settings, facilitate discharges, and provide continuous care coordination.
Document comprehensive care activities in DCMS (EMR) and other applicable software in compliance with standards.
Contribute to corporate goals through member care plans and goal achievement.
Perform additional HARP behavioral health duties and participate in special projects such as audit review, quality improvement, community health education, provider relations, and marketing activities.
Minimum Qualifications
Master's Degree required.
3–5 years of behavioral health experience (serious mental illness & substance use disorder) in managed care, psychiatric inpatient and/or outpatient settings, with case and utilization management; 1‑year HARP experience preferred.
Field‑based case management experience within the Integrated Collaborative Care Model.
Experience managing chronic conditions such as diabetes, HIV, heart disease.
Knowledge of pharmacy, psyched, e‑paces, HCS (UAS), MAPP, CORE/HCBS, Microsoft Teams Video.
Strong interpersonal assessment skills, calm during crisis situations.
History of conducting home visits and bedside assessments at inpatient or residential settings.
Medical background and bilingual preferred.
Experience as a quality‑management liaison with hospitals and large‑volume providers, addressing cost and HEDIS/QARR performance, preferred.
Licensure and/or Certification Required
Licensed Mental Health Counselor (LMHC), Licensed Marriage and Family Therapist (LMFT), Licensed Master Social Worker (LMSW), or Licensed Clinical Social Worker (LCSW) issued by NYSED.
Professional Competencies
Integrity and Trust.
Teamwork and problem‑solving attitude.
Customer service with member‑first focus.
Superior technical computer skills (Microsoft Office, DCMS, Teams Video).
Clear and concise written and oral communication.
Exceptional organizational and communication skills.
#J-18808-Ljbffr
127673 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 Salary Range:
$95,000.00 - $95,000.00
About the Organization MetroPlusHealth, a wholly‑owned subsidiary of NYC Health + Hospitals, provides health services across New York City. We focus on empowering communities and delivering quality care to patients, including managed care, Medicare, Medicaid, and other programs.
Position Overview The Health and Recovery Plan (HARP) Care Manager develops, facilitates, and communicates a plan of care with members, Health Homes, caregivers, physicians and behavioral health providers. The role assesses, plans, facilitates, and advocates for services, manages after‑care follow‑up for acute behavioral health discharges, and ensures member compliance with follow‑up appointments.
Work Shifts 9:00 am – 5:00 pm
Duties & Responsibilities
Clinically assess members for acute behavioral and physical health needs and generate referrals to providers and community resources.
Conduct utilization review for designated case‑management members at diversionary levels of care (CORE/HCBS, ACT).
Meet with members in homes, shelters, residential settings, community agencies, hospital inpatient units, and day hospital programs.
Conduct initial and ongoing behavioral health clinical assessments.
Develop formal plans of care and notify physicians of any changes.
Assist members in accessing post‑discharge aftercare appointments and coordinate with inpatient teams for suitable follow‑up.
Outreach members regarding 7‑day follow‑up appointments and offer 30‑day appointments as part of HEDIS measures.
Mail discharge aftercare letters with referral lists to members not reached by phone.
Collaborate with assigned nurses for timely clinical updates to plans of care.
Document IDT care‑coordination notes with internal staff and external Health Home/CMA workers.
Review and approve submitted Health Home plans of care and CORE/HCBS requests; educate CMA workers on PROS and IOP options.
Assist providers in achieving pay‑for‑performance goals and explore value‑based payment feasibility.
Educate providers on medication adherence and use of long‑acting injectables.
Promote first‑episode psychosis treatment within provider network.
Advise providers on alternative treatment services in place of inpatient detox.
Attend and prepare for bi‑weekly interdisciplinary care team meetings for high‑utilizing HARP members.
Oversee delivery of comprehensive, cost‑effective healthcare for all members.
Evaluate housing needs and assist with housing applications, collaborating with internal housing team.
Coordinate services across settings, facilitate discharges, and provide continuous care coordination.
Document comprehensive care activities in DCMS (EMR) and other applicable software in compliance with standards.
Contribute to corporate goals through member care plans and goal achievement.
Perform additional HARP behavioral health duties and participate in special projects such as audit review, quality improvement, community health education, provider relations, and marketing activities.
Minimum Qualifications
Master's Degree required.
3–5 years of behavioral health experience (serious mental illness & substance use disorder) in managed care, psychiatric inpatient and/or outpatient settings, with case and utilization management; 1‑year HARP experience preferred.
Field‑based case management experience within the Integrated Collaborative Care Model.
Experience managing chronic conditions such as diabetes, HIV, heart disease.
Knowledge of pharmacy, psyched, e‑paces, HCS (UAS), MAPP, CORE/HCBS, Microsoft Teams Video.
Strong interpersonal assessment skills, calm during crisis situations.
History of conducting home visits and bedside assessments at inpatient or residential settings.
Medical background and bilingual preferred.
Experience as a quality‑management liaison with hospitals and large‑volume providers, addressing cost and HEDIS/QARR performance, preferred.
Licensure and/or Certification Required
Licensed Mental Health Counselor (LMHC), Licensed Marriage and Family Therapist (LMFT), Licensed Master Social Worker (LMSW), or Licensed Clinical Social Worker (LCSW) issued by NYSED.
Professional Competencies
Integrity and Trust.
Teamwork and problem‑solving attitude.
Customer service with member‑first focus.
Superior technical computer skills (Microsoft Office, DCMS, Teams Video).
Clear and concise written and oral communication.
Exceptional organizational and communication skills.
#J-18808-Ljbffr