Overview Position: Care Manager - Registered Nurse at MetroPlusHealth
Base pay range: $112,351.00/yr - $112,351.00/yr
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\'s network includes over 27,000 primary care providers, specialists and participating clinics. For more than 40 years, MetroPlusHealth has been committed to building strong relationships with its members and providers.
Position Overview The Care Manager develops, prior approves, facilitates, monitors, and communicates a care plan in partnership with the member, family or significant other, primary caregiver, the primary and/or attending physicians, and various providers. Using the assessments and interview done by the Assessment Nurse, the Care Manager identifies risk factors, strengths, challenges, and service needs of the member to keep them in their community setting.
Work Shifts 9:00 AM - 5:00 PM
Responsibilities Review and evaluate the assessment and UAS information.
Develop a working relationship with the PCP to discuss care of the member with the PCP.
Review assessment findings and risk categories with PCP to identify concerns not yet identified.
Identify risk factors and assign the risk category to the member.
Develop with the team the individual member disaster plan.
Develop a formal care plan for all services needed for the member in collaboration with the Care Management team.
Monitor the member\'s condition by phone or face-to-face as needed.
Identify clinical issues requiring immediate assessment and/or treatment to reduce risk of unnecessary hospitalizations, ED visits or nursing home admissions.
Prior approve requests for additional services based on assessments and using evidence-based standards; refer denial, reduction, or limitation of service requests to Medical Director.
Assist members with coordination of services within and outside the network as appropriate, including facilitating discharge from acute settings and alternate settings.
Provide Care Coordination through the continuum of care.
Optimize quality of care and quality of life for MetroPlusHealth members.
Coordinate with UM department on concurrent and retrospective review.
Follow up with assigned nurses for clinical updates to the care plan.
Document coordination notes and routine contacts with members within two business days according to risk level.
Participate in team care planning meetings.
Handle complaints that can be resolved in one day.
Assist Customer Service and the UM department by providing records and materials needed for grievances from MLTC program members.
Speak to members who are delinquent in their spend-down payments.
Cooperate with all departments within MetroPlusHealth.
Identify members appropriate for specialty programs.
Perform all MLTC management activities in compliance with regulatory agency requirements.
Provide information to the Manager of MLTCP on all requests from QM department to be reviewed by QA committees.
All other tasks assigned by the Director of Long Term Care Clinical Programs or Medical Director.
Participate in the department on-call schedule as needed, rotated amongst the care team.
Minimum Qualifications Bachelor\'s Degree required; BSN preferred.
Two (2) to three (3) years clinical experience in CHHA, Lombardi program and/or MLTC.
Active New York State License as Registered Nurse.
Professional Competencies Integrity & Trust
Customer Service Focus
Functional/Technical Skills
Written/Oral Communication