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HARP Care Manager

Job Ref: 63573
Category: Utilization Review and Case Management
Location: 50 Water Street, 7th Floor, New York, NY 10004
Job Type: Regular
Employment Type: Full-Time
Hire In Rate: $93,000.00
Salary Range: $93,000.00 - $98,000.00

About NYC Health + Hospitals

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

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. Collaborate the process of assessment, planning, facilitation and advocacy for options and services to meet a HARP member’s complex health needs through communication and available resources.

Interviewing now, 13 positions available: 6 with start date in Q2 2021, 4 with start date in Q3 2021, 2 with start date in Q4 2021 and 1 with start date in Q1 2022  

Job Description

  • 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. (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.
  • Collaborate timely follow up with assigned nurses for clinical updates to plans of care.
  • Document IDT care coordination notes between both internal MetroPlus 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 HCBS requests; educating CMA workers about PROS and IOP options for members who opt out of receiving 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 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 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 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

  • Overall, 3-5 years of Behavioral Health (Serious Mental Illness & Substance Use Disorder) experience in a managed care and or in a Psychiatric Hospital Inpatient and/or Outpatient experience with both case and utilization management. One-year HARP experience preferred.
  • Case Management Experience within the Integrated Collaborative Care Model Approach
  • Experience with chronic condition management, particularly Diabetes, HIV, Heart Disease
  • Pharmacy, Psyckes, E-Paces, HCS (UAS) MAPP, Microsoft Teams Video knowledge
  • Medical Background & Bilingual preferred.
  • Strong interpersonal and assessment skills, the ability to remain calm and poised with challenging members who often present as in a constant state of crisis.
  • Previous history of conducting home visits to members as well as assessing them bedside during an inpatient hospitalization or at their long-term Substance Abuse Residential setting.
  • Previous Quality Management liaison experience with hospitals and other large volume providers to address cost. as well as HEDIS/QARR quality performance, preferred.
  • Exceptional Organizational and Communication Skills.

Licensure and/or Certification Required:

  • LPN, LCSW, LMSW, LMHC, RN, CASAC. Current valid unrestricted NY State License.

Professional Competencies:

  • Integrity and Trust
  • Teamwork and Problem-Solving Attitude
  • Customer Service Member FIRST Focus
  • Superior Technical Computer skills (Microsoft Office, DCMS, Teams Video Application)
  • Clear and Concise Written/Oral Communications