Health care manager Jobs in USA

Summary of Job

Provide telephonic and in-person community-based care management services for populations with behavioral health and / or substance use disorders. Community locations could include ACPNY offices, Neighborhood Care Centers, EH Pharmacies, Hospitals, and members' homes. Conduct assessments, develop care plans, and provide interventions with the goal of reducing psychiatric ED visits and hospitalizations / re-hospitalizations, increasing member stability in the community, and reducing avoidable medical utilization driven by BH / SUD. Collaborate with medical case managers, internal and external utilization management teams, community-based care managers (e.g. Health Home) and other members of the care management team to provide care management services to members identified with behavioral health care needs. Coordinate and provide care that is safe, timely, effective, efficient and member centered to support EH population health and complex care management initiatives. Engage with high-risk members of the health plan with the goal of improving health care outcomes and appropriate and timely utilization of services across the continuum of care. Perform specific activities to support members during transitions of care, and closure of members' gaps in care. Ensure completion of all activities required for compliance with laws, regulations, and accreditation standards.

Responsibilities :

• Locate and refer patients to community resources and support while working collaboratively with mental health providers to develop creative, cost-effective continuing care plans; identify alternate levels of care as needed and works with interdisciplinary team to improve health outcomes.
• Refer members to appropriate behavioral health care providers and programs as well as resources to address social determinants of health.
• Assess identified members for care management services in accordance with care management strategies.
• Engage with all members of the multidisciplinary care team serving as an advocate to members with the goal of improving health outcomes and stability.
• Enroll members into appropriate care management programs.
• Engage and collaborate with staff in contracted Health Homes.
• Provide ongoing support and education to patient and family members that includes regular telephonic contact with patient and / or family to assess mental health status and assure treatment compliance.
• Document all case management interventions in a thorough and timely manner while meeting all NCQA documentation requirements for complex care management.
• Develop member-centered care plans and delivers personalized, clinically rigorous interventions tailored to the members' diagnoses, strengths, challenges, and needs.

Qualifications :