Director of HARP Case Management
Job Ref: 55358
Category: Utilization Review and Case Management
Department: BEHAVIORAL HEALTH HARP
Location: 160 Water St. #3, New York, NY
Job Type: Regular
Employment Type: Full-Time
Hire In Rate: $140,000.00
Salary Range: $140,000.00 - $155,000.00
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.
The HARP Clinical Director (HCD) manages the operational, regulatory, clinical, and oversight activities of the Health and Recovery Plan Line of Business. The HARP Clinical Director is responsible for high touch coordination between MetroPlus, Health Homes, and HCBS Providers. The HCD works with the Plan’s Medical Director to ensure that members receive all medically necessary care, proper health home coordination services, timely review of POCs, and appropriate HCBS services.
- Participate in the development and articulates the vision and strategic direction for Behavioral Health; collaboration on the implementation of strategies.
- Responsible for oversight of the HARP Case Management and Health Homes.
- Works closely with the clinical staff to ensure the provision of Behavioral Health Services, Health Home coordination, and needed HCBS services to members.
- Works with the MetroPlus quality departments on quality improvement projects, Performance Improvement Plans, and relevant HEDIS and QARR activities.
- Responsible for timely and accurate reporting to the MetroPlus BH Core Subcommittee.
- Ensures that the clinical team complies with case management requirements articulated in the Model of care.
- Ensure compliance with Federal, State, and City regulations as they relate to Behavioral Health and Health Homes.
- Participate in the direct oversight of the plan’s HARP membership as it relates to Behavioral Health and Health Homes.
- Provide oversight of all the HCBS services provided by the Health Homes.
- Works with Metro Plus’s customer service to ensure that Members issues or concerns are addressed/ resolved in a timely fashion.
- Oversees Health Home assessment and assignment activities and conducts monthly oversight meetings with Health homes.
- Sets program goals and implements continuous improvement activities to achieve them.
- Must be familiar with the OMH, DOH, OASAS regulations for service delivery, with a care coordination approach to service delivery in a managed care setting.
- Establish and maintain appropriate systems and scorecards for measuring necessary aspects of operational management and development.
- Ensures the monitoring of care coordination, UAS assessments, and HCBS services provided by Health Homes and HCBS providers.
- Works with MIS, Core Configuration, Claims, Provider Contracting and other internal departments both within MetroPlus to ensure smooth operations of the unit.
- Perform other duties as assigned by the Medical Director, and the Behavioral Health Associate Executive Director.
- Must have a minimum of 10 years working in a health care management company.
- Must have at least 5 years of experience in a management position.
- Must have a thorough knowledge of the Medicaid Managed Care Organization
- Experience working with Health Homes.
- Knowledge of QM and UM activities and reporting.
- Clinical experience, a plus.
- An equivalent combination of education, training and experience, knowledge and skills sufficient to indicate the ability to perform satisfactorily
Licensure and/or Certification Required
- Master’s degree in social services, higher degree preferred
- NYS license required; LCSW or LMHC preferred.
- Integrity and Trust
- Management and leadership skills
- Ability to work on a few tasks at the same time under a strict timetable
- Excellent written/oral communication skills
- Ability to collaborate with different stakeholders.
- Functional Skills
- Excellent organizational skills