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Overview The Care Manager plans and manages behavioral and/or physical care with members and works collaboratively with them, their supports, providers, and health care team members. The Care Manager applies care management principles when engaging members and coordinating health care services to provide an excellent member experience, address barriers, and improve health outcomes. The Care Manager is assigned to a specific product line such as CompleteCare, SNP, Medicaid/Medicare, PHSP, HARP, etc.
Responsibilities Advocates, informs, and educates beneficiaries on services, self-management techniques, and health benefits.
Conducts assessments to identify barriers and opportunities for intervention.
Develops care plans that align with the physician’s treatment plans and recommends interventions that align with proposed goals.
Generates referrals to providers, community-based resources, and appropriate services to support goal achievement and maintenance of successful health outcomes.
Liaises between service providers such as doctors, social workers, discharge planners, and community-based service providers to ensure care is coordinated and needs are addressed.
Coordinates and facilitates with the multi-disciplinary health care team to ensure care plan goals are person-centered and maximize member health outcomes.
Assists in identifying opportunities for alternative care options based on member needs and assessments.
Evaluates service authorizations to ensure alignment with and execution of the member’s care and physician treatment plan.
Contributes to corporate goals through ongoing execution of member care plans and goal achievement.
Documents all encounters with providers, members, and vendors in the appropriate system in accordance with internal documentation procedures; follows up as needed; and updates care plans based on member needs.
Occasional overtime as necessary.
Additional duties as assigned.
Minimum Qualifications For Medical Care Management:
NYS RN or
LCSW or LMSW (any state)
For PEDS positions only: 1 year of pediatric clinical field experience and/or experience with families and child serving systems, including child welfare and/or medically fragile/developmentally disabled populations
For Behavioral Health (BH) Care Management:
NYS RN or
LCSW, LMSW, LMFT, LMHC, LPC, licensed psychologist (any state)
3 years of work experience in a mental/behavioral health or addictions setting
For BH PEDS positions only: 1 year of pediatric clinical field experience and/or experience with families and child serving systems, including child welfare and/or medically fragile/developmentally disabled populations
Preferred Qualifications Strong interpersonal and assessment skills, especially the ability to relate well with seniors, their families, and community care providers, along with demonstrated ability to handle rapidly changing situations.
Fluency in Bengali
Knowledge and experience with current community health practices for frail adults and cognitively impaired seniors.
Experience managing member information in a shared network environment using paperless database modules and archival systems.
Experience and knowledge of the relevant product line
Relevant work experience preferably as a Care Manager
Demonstrated ability to manage large caseloads and effectively work in a fast-paced environment
Proficient with navigating the Internet and multi-tasking with multiple electronic documentation systems
Experience using Microsoft Excel with the ability to edit, search, sort/filter and other Microsoft and PHI systems
Hiring Range Greater New York City Area (NY, NJ, CT residents): $81,099 - $116,480
All Other Locations (within approved locations): $71,594 - $106,080
As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.
In addition to your salary, Healthfirst offers employees a full range of benefits such as medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits subject to eligibility requirements). Healthfirst provides a competitive compensation and benefits package wherever its employees work and live.
Note on Hiring Range The hiring range is defined as the lowest and highest salaries that Healthfirst in good faith would pay to a new hire, or for a job promotion or transfer into this role.
Senioritiy level Not Applicable
Employment type Full-time
Job function Health Care Provider
Industries: Hospitals and Health Care
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