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Job Details

Care Management Associate I

Job Ref: 53271
Category: Professional
Department: UTILIZATION MANAGEMENT
Location: 160 Water St. #3, New York, NY
Job Type: Regular
Employment Type: Full-Time
Hire In Rate: $40,000.00
Salary Range: $40,000.00 - $44,000.00

Marketing Statement

MetroPlus Health Plan 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’ network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlus has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life. 

Position Overview 

Overview The primary function of the Care Management Associate (CMA) is to be member advocates by coordinating medical, health, social and other available services with the goals of improving health outcomes and experience, while containing healthcare costs. This is accomplished in a variety of settings in conjunction with care partners such as members, caregivers, health care providers, community-based agencies, retail businesses (e.g. pharmacies), and other support agencies. CMAs deliver services mostly on site in the community, health care facilities, and member’s homes and as needed, telephonically. 
 Under the direction of a Care Manager in conjunction with care partners, Care Management Associates will assist members to improve compliance with preventive care, smoothly transition from the hospital, emergency room, or other health care site, ensure a safe return to their discharge destination. The outcomes of these efforts include but are not limited to reductions in emergency room visits, reduction in re-hospitalizations, compliance and self-management with their treatment program, and appropriate follow up medical care. 

After establishing a trusting partnership with the member/caregiver, the Care Management Associate will participate by assisting the member to attain and comply with the prescribed medication regime, diet, medical and nursing treatments, and follow up care. In addition, the CMA will assist the member and or pursue on members’ behalf to establish relationships with community-based organizations to support the goals of service. If indicated, the Case Management Associate will be supported by a Care Manager for intensive clinical issues, but the primary responsibility for members’ outcomes will stay with the CMA. The CMA will be proactive in supporting the member to prevent recurrence or relapse of illness while ensuring satisfaction, improved health and wellness, improved health literacy, and progressively increasing autonomy. 

Job Description

  • Problem solve member’s issues in an independent, resourceful manner 
  • Perform non-clinical activities for members of varying age, clinical scenario, culture, financial means, social support, and motivation 
  • Be member’s advocate and assist in involved, hands on manner with accomplishing their treatment goals. 
  • Engage members/caregivers in a collaborative relationship, empowering them to manage their physical, psychosocial and environmental health to improve and maintain lifelong well being 
  • Screen members according to MetroPlus Health Plan policies and procedures, assisting members to identify appropriate support activities and services to maximize health and wellness. 
  • Coordinate required services in accordance with member, caregiver, clinical and non–clinical providers, and care managers when involved 
  • Advocate for members by assisting them to address challenges, and make informed choices regarding the use of social and other community supports 
  • Develop collaborative relationships with clinical providers and facility staff 
  • Promote communication, both internally and externally to enhance effectiveness of clinical and non-clinical services and overall case management services 
  • Assist members in understanding mechanics and management of health care and social support networks 
  • Maintain accurate and complete documentation of required information in compliance with risk management, regulatory and accreditation requirements 
  • Assist member in research and understanding of benefit and claims information and resolution 
  • Protect the confidentiality of member information and adheres to all company policies regarding confidentiality 
  • Employ critical thinking and judgment when dealing with unplanned issues 
  • Collect and prepare data, statistics, proposals and reports relevant to responsibilities as a Care Manager Associate 
  • Comply with all orientation requirements, annual and other mandatory trainings, organizational and departmental policies and procedures, and actively participate in evaluation process 
  • Maintain professional competencies as a Care Manager Associate 
  • Other duties as assigned by Manager.

Minimum Qualifications

  • Problem solve member’s issues in an independent, resourceful manner 
  • Perform non-clinical activities for members of varying age, clinical scenario, culture, financial means, social support, and motivation 
  • Be member’s advocate and assist in involved, hands on manner with accomplishing their treatment goals. 
  • Engage members/caregivers in a collaborative relationship, empowering them to manage their physical, psychosocial and environmental health to improve and maintain lifelong well being 
  • Screen members according to MetroPlus Health Plan policies and procedures, assisting members to identify appropriate support activities and services to maximize health and wellness. 
  • Coordinate required services in accordance with member, caregiver, clinical and non–clinical providers, and care managers when involved 
  • Advocate for members by assisting them to address challenges, and make informed choices regarding the use of social and other community supports 
  • Develop collaborative relationships with clinical providers and facility staff 
  • Promote communication, both internally and externally to enhance effectiveness of clinical and non-clinical services and overall case management services 
  • Assist members in understanding mechanics and management of health care and social support networks 
  • Maintain accurate and complete documentation of required information in compliance with risk management, regulatory and accreditation requirements 
  • Assist member in research and understanding of benefit and claims information and resolution 
  • Protect the confidentiality of member information and adheres to all company policies regarding confidentiality 
  • Employ critical thinking and judgment when dealing with unplanned issues 
  • Collect and prepare data, statistics, proposals and reports relevant to responsibilities as a Care Manager Associate 
  • Comply with all orientation requirements, annual and other mandatory trainings, organizational and departmental policies and procedures, and actively participate in evaluation process 
  • Maintain professional competencies as a Care Manager Associate 
  • Other duties as assigned by Manager.

Professional Competencies

  • Integrity and Trust
  • Customer Focus
  • Functional/Technical skills
  • Written/Oral Communication