Job Search

One Mission. More Than Half a Million Reasons.
As we empower every New Yorker
to live the healthiest life possible.

Share This Job
Job Details

Health & Wellness Advisor II (LCSW/LMSW)

Job Ref: 67244
Category: Utilization Review and Case Management
Department: PARTNERSHIP IN CARE
Location: Staten Island, NY
Job Type: Regular
Employment Type: Full-Time
Hire In Rate: $78,989.00
Salary Range: $78,989.00 - $78,989.00

This is a field position, so while you may have a preference for a specific area, please note that you may be deployed to a different area, based on the organization's needs.

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:


Under the direction of the Director of Partnership in Care, the Health & Wellness Advisor (Level 2) ensures the promotion of health and wellness of HIV+/AIDS and other SNP members with medium and high 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. In the instance of co-management with behavioral health services, the Health & Wellness Advisor (Level 2) ensures all of the above except co-morbid mental health and substance abuse needs and services. Deployed to health care
facilities through-out New York City to provide case management services as outlined in the managed care agreement.

Job Description

Provide face-to-face case management services to members at assigned health care facilities.


• 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.


• 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.
DocuSign Envelope ID: EA6BA088-3554-43BC-BF45-ED44D5EA6B1D


• 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.


• Mentors and supports the work of HIV Services Health & Wellness Advisors (Level 1) on their
assigned team and other teams when requested and participates in the competency
development of HIV Services Health & Wellness Advisors (Level 1).


• 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.
 

Minimum Qualifications

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.


• Excellent interpersonal, organizational communication and analytical skills.


• Computer literacy with proficiency with Microsoft Office products is required.


• Bilingual (English/Spanish) is preferred. Fluency in other languages is welcomed.

New York State license as an LCSW or LMSW is required