NYC Health + Hospitals provided pay range
This range is provided by NYC Health + Hospitals. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.
Base pay range
$112,351.00/yr - $112,351.00/yr
Marketing Statement
MetroPlus Health 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, MetroPlus Health’s network includes over 27,000 primary care providers, specialists and participating clinics. For more than 40 years, MetroPlus Health has been committed to building strong relationships with its members and providers.
Position Overview
The primary goal of the Care Manager is to optimize members’ health care and delivery of care experience with expected cost savings due to improved quality of care. This is accomplished through engagement and understanding of the member’s needs, environment, providers, support system and optimization of services available to them. Care Manager is expected to assess and evaluate member’s needs, be a creative, efficient, and resourceful problem solver. In collaboration with the members’ care team, a plan of care with individualized goals and interventions is developed, implemented and outcomes evaluated.
Duties & Responsibilities
Address member’s problems and needs: clinical, psychosocial, financial, environmental
Provide services to members of varying age, risk level, clinical scenario, culture, financial means, social support, and motivation
Engage members in a collaborative relationship, empowering them to self-manage their physical, psychosocial, and environmental health to improve and maintain lifelong well being
Prepare member‑oriented plan of care with member, caregivers, and health care providers, integrating concepts of cultural sensitivity and privacy practices
Participate in interdisciplinary rounds
Ensure plans of care have individualized goals and interventions
Communicate plan of care to Primary Care Physician
Address gaps in care with the member and provider
Address members' social determinants of health issues
Link members to available resources
Provide care management support during Transitions of Care
Ensure member/caregiver understanding as it relates to language barriers, stress reaction or cognitive limitations/barriers
Train member on relevant chronic diseases, preventive care, medication management (medication reconciliation and adherence), home safety, etc.
Provide complex care management including ensuring access to care, reducing unnecessary hospitalizations, and appropriately referring to community supports
Advocate for members by assisting them to address challenges and make informed choices regarding clinical status and treatment options
Employ critical thinking and judgment when dealing with unplanned issues
Maintain knowledge of chronic conditions and use job aids as a guide
Maintain accurate, comprehensive, and current clinical and non‑clinical documentation in DCMS, the Care Management System
Comply with all orientation requirements, annual and other mandatory trainings, organizational and departmental policies and procedures, and actively participate in the evaluation process
Maintain professional competencies as a Care Manager
Other duties as assigned by Manager
Minimum Qualifications
Bachelor’s Degree required
Minimum 2 years’ prior experience in a health care setting, Care Management, or Managed Care setting required
Ability to proficiently read and interpret medical records, claims data, pharmacy, lab reports and prescriptions required
Registered Nurse with current NYS license.
Ability to work closely with member and caregiver.
Core Competencies
Integrity and Trust
Customer Focus
Proficiency with computers navigating in multiple systems and web‑based applications
Confident, autonomous, solution‑driven, detail‑oriented, high standards of excellence, nonjudgmental, diplomatic, resourceful, intuitive, dedicated, resilient and proactive
Strong verbal and written communication skills including motivational coaching, influencing and negotiation abilities
Time management and organizational skills
Strong problem‑solving skills
Ability to prioritize and manage changing priorities under pressure
Must know how to use Microsoft Office applications including Word, Excel, PowerPoint and Outlook
Ability to form effective working relationships with a wide range of individuals
Seniority level
Entry level
Employment type
Full‑time
Job function
Health Care Provider
Hospitals and Health Care
Department Preferences
(Not specified)
Benefits
Benefits include typical healthcare provider benefits (details not provided).