Health and Recovery Plan Care Manager

Health and Recovery Plan Care Manager

Job Ref : 127456

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

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

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 HARP Care Manager develops, facilitates, and communicates a plan of care in partnership with the member, his / her assigned Health Home, primary caregiver, the primary and attending physicians, and various Behavioral Health and / or substance use disorder providers. In partnership with these parties, the HARP Care Manager assesses, plans, facilitates, and advocates for options and services to meet a HARP member's complex health needs through communication and available resources. In addition, the HARP Care Manager is responsible for scheduling aftercare follow-up for members discharging from an acute behavioral health inpatient setting. This position ensures that members have a scheduled appointment in place, completes follow-up and reminder call to member and follows up with providers to ensure member's compliance with aftercare. This position requires that most case management activities will be performed in field via community and facilities outreach.

Work Shifts

9 : 00 AM- 5 : 00 PM

Duties & Responsibilities

• Clinically assess members for acute behavioral and physical health needs. Generating referrals to providers, community-based resources, and appropriate services and other resources to assist in goal achievement.
• Conduct Utilization Review for designated Case Management members for some diversionary levels of care. (CORE / HCBS, ACT).
• Expected to 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 HARP member. Notify physicians for any changes in member's plan of care.
• Assists members and providers in accessing post-discharge aftercare related appointments. Works with inpatient facility team to identify appropriate follow-up care for CORE and HARP BH members.
• Responsible for outreaching members regarding adhering to 7-day follow up appointment to offer a 30-day appointment as part of HEDIS measures
• Responsible for mailing discharge aftercare letters with a list of referrals to members not reached by phone.
• Collaborate timely follow up with assigned nurses for clinical updates to plans of care.
• Document IDT care coordination notes between both internal MetroPlus Health staff and external Health Home / CMA workers.
• Review and Approve submitted Health Home Plans of Care and ensure that CMA's are conducting timely annual assessments. Review and approve CORE / HCBS requests; educating CMA workers about PROS and IOP options for members who opt out of receiving CORE / HCBS.
• Assist providers with achieving pay for performance goals and examine the feasibility of Value Based Payment with high volume providers for HARP line of business.
• Educate providers on medication and treatment compliance while also promoting the use of Long Acting Injectables.
• Enlist existing provider network in promoting first episode psychosis treatment.
• Educate providers to alternate treatment services being promoted by Health + Hospitals in lieu of Inpatient Detox Attends and prepares for bi-Weekly Interdisciplinary Care Team (ICT) meetings which will feature newly enrolled, frequently admitted, high utilizing at risk HARP members.
• Oversee the coordination and delivery of comprehensive, quality healthcare and services for all members requiring care management in a cost-effective manner.
• Evaluate housing needs appropriately and assist with housing application process. Collaborating timely with MetroPlus Health internal housing team for supportive assistance.
• Assist members with the coordination of services from various settings as appropriate. Including facilitating discharge from acute setting and alternate settings.
• Provides Care Coordination throughout the continuum of care.
• Optimizes both the quality of care and the quality of life for the MetroPlus Health members. Identifies members appropriate for specialty programs.
• Documents in a comprehensive manner to ensure that all goals, interventions, and care coordination activities for each member in DCMS (EMR) system, and other applicable software programs, are complaint with professional standards and regulatory guidelines.
• Contributes to MetroPlus Health corporate goals through ongoing execution of member care plans and member goal achievement.
• Performs other appropriate HARP Behavioral Health duties and participates in other special projects as assigned, including, but not limited to, audit review and preparation, quality improvement, community health education, facility / provider relations and marketing activities.

Minimum Qualifications

Licensure and / or Certification Required :

Professional Competencies