Health & Wellness Advisor I
Job Ref: 53148
Department: PARTNERSHIP IN CARE
Location: 160 Water St. #3, New York, NY
Job Type: Regular
Employment Type: Full-Time
Hire In Rate: $51,849.00
Salary Range: $51,849.00 - $51,849.00
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.
With the support of the Health & Wellness Advisor (Level 2), the Health & Wellness Advisor (Level 1) ensures the promotion of health and wellness of HIV+/AIDS and other SNP members with low and medium level acuity through the oversight and development of a Plan of Care that encompasses the assessment of health and psychosocial needs, ongoing retention and engagement in care, high level adherence to antiretroviral therapy, health education and coaching on HIV disease, HIV primary and secondary risk reduction, and other co-morbid illnesses, and referral to community resources and services when appropriate. The Health & Wellness Advisor (Level 1) works in conjunction with the Health & Wellness Advisor (Level 2) in a team-oriented approach.
- Orients the assigned new member and reorients existing members to MetroPlus Health Plan and the scope of services the plan provides as needed.
- Ensures, formulates and validates an individualized Plan of Care utilizing various databases and collateral resources such as the member, care giver, primary care provider, and/or community level case manager to identify the needs and barriers of members living with HIV in order to promote the health and wellness of the member.
- Ensures that the Plan of Care identifies appropriate goals and interventions.
- Promotes access to and oversees the coordination and delivery of comprehensive, quality healthcare services for HIV+ and homeless members.
- Performs telephonic case management activities where needed, including care coordination, planning for transition of care, out-patient follow-up and ancillary service review throughout the continuum of care to ensure optimum health outcomes.
- Provides health education on HIV disease, HIV primary and secondary risk reduction and other co-morbid illnesses, such as hepatitis C, diabetes and hypertension as indicated by the Plan of Care.
- Communicates with the member’s primary care provider, community case manager and all other applicable providers, vendors or agencies to facilitate the health and wellness of the member in a coordinated and comprehensive manner.
- Identifies service utilization trends and potential member needs by means of reviewing encounter data, pharmacy/prescription data, and the review of member health assessment tools.
- Documents in a comprehensive manner to ensure that all goals, interventions and care coordination activities for each member in the DCMS system and other applicable software programs are in compliance with professional standards and regulatory guidelines.
- Ensures each assigned new SNP member has a completed Plan of Care within 30 days of enrollment and a reassessment of the Plan of Care every 180 days.
- Attends and prepares for bi-weekly Interdisciplinary Care Team (ICT) meetings which will present newly enrolled, frequently admitted, and inpatient transition of care cases. To review, identify and assess the member’s Plan of Care and recommend changes in order to promote the health and wellness of the member.
- Serves as the principal contact/representative of Partnership In Care program for the member.
- Assists all MetroPlus departments with resolution of related member retention, utilization management, quality management, customer service, and provider relations concerns.
- Attends approved in-service and external education and training as per department directives.
- Performs other appropriate 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.
- Ensures that coordination of membership enrolled in all lines of business is compliant with Federal, State, and City regulations, and are consistent with the Mission, Vision and Values of the organization.
- Bachelor’s degree from an accredited college or university in a healthcare-related field is required. Master’s degree from an accredited college or university in Nursing, Social Work or other healthcare related discipline is preferred.
- A minimum of two years of clinical experience in HIV care or support systems that includes experience in care coordination, health education and case management. A minimum of two years of experience in managed care is preferred.
- Integrity and Trust
- Customer Focus
- Functional/Technical Skills
- Written/Oral Communications