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Health Home Liaison

Job Ref: 68125
Category: Professional
Location: 50 Water Street, 7th Floor, New York, NY 10004
Job Type: Regular
Employment Type: Full-Time
Hire In Rate: $83,000.00
Salary Range: $73,000.00 - $83,000.00

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
The goal of the Health Home Liaison is to coordinate services to eligible MetroPlus members through a contractual agreement with designated Health Homes. The Health Home Liaison acts as a point of contact between MetroPlus and the Health Homes to facilitate coordination of member’s care and to achieve optimum health status. The core of this position is to ensure access to appropriate services, improve outcomes, reduce hospitalization and emergency room visits, promote Health Information technology such as MAPP and Psyckes to assist lead health homes and care managers.

Job Description

Scope of Role & Responsibilities

  • Serves as the Plan’s point of contact for all internal and external entities to address Health Home-related issues. This includes NYS DOH, lead Health Homes, Care Management, agencies, all MetroPlus internal departments as well as MetroPlus’ Behavioral Health Vendor Beacon Health Options.
  • Works collaboratively with MetroPlus’ Claims Department as well as with Health Home billing vendors to resolve any claims or billing issues to ensure timely and accurate processing of claims.
  • Assigns Health Home eligible members identified by NYS DOH and MetroPlus Health Plan, based on present and historic diagnostic treatment profile, provider history, catchment area, and populations’ specialties or treatment orientations.
  • Reviews assessments for ground-up Health Home referrals and coordinates medical, behavioral, and psychosocial services when making Health Home referrals; completes and records all interventions in a timely matter.
  • Tracks health home outreach outcomes and assists in developing and monitoring interventions and corrective action plans.
  • Facilitates regular meetings and ongoing communication with Health Home agencies to ensure optimal functioning.
  • Works collaboratively with the Medical Management team to implement tools for quality assurance and program evaluation to ensure regulatory, contractual, and clinical compliance are met.
  • Good knowledge of regulatory and contractual guidelines to ensure compliance.
  • Assists with NCQA, URAC, and other QI initiatives.
  • Participate in interdisciplinary case conferences and support case managers in terms of tracking enrollment and referrals for the plan.
  • Review Gaps in care with lead health homes and address gaps closure.
  • Employ critical thinking and judgment when dealing with unplanned issues.
  • Additional duties delegated by the supervisor.

Minimum Qualifications

  • Master's degree in social work, public health, or other related fields.
  • At least five years of experience in a managed care company managing health homes preferred.
  • Excellent verbal and written communication skills.
  • Good excel skills to create reports to the leadership.

Licensure and/or Certification Required:

  • NONE

Professional Competencies:

  • Integrity and Trust
  • Customer Focus
  • Functional/ Technical Skills 
  • Clear and Concise Written/Oral Communications