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Job Details

Personal Health Coach - Social Worker

Job Ref: 57570
Category: Utilization Review and Case Management
Location: 160 Water St. #3, New York, NY 10038
Job Type: Regular
Employment Type: Full-Time
Hire In Rate: $51,500.00
Salary Range: $51,000.00 - $51,000.00

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 primary goal of the Personal Health Coach is to optimize members’ health care and delivery of care experience with expected cost savings due to improved quality of care. This is accomplished through engagement and understanding of the member’s needs, environment, providers, support system and optimization of services available to them. Personal Health Coachworks under the direction of a Licensed Social Worker Care Manager and/or Team Lead to coordinate services member’s needs, using all available internal and external community resources. This will be accomplished through in field work in member’s homes, facilities, provider offices and community resources. The Personal Health Coach serves as member’s advocate and accompanies the member throughout their care journey.
The Personal Health Coach is monitored and assessed based on value added to improved health status of member. That includes, but not limited to adherence with provider visits, gap in care, and utilization of emergency services, hospitalizations and avoidable complications. The Personal Health Coach’s primary role is to support members in need and problem solve issues in a beneficial manner for the member and Plan. The support is comprehensive and includes health, social, financial, environmental and safety aspects.

This is a hands on, involved, predominately field based position and will require travel within the MetroPlus Health Plan service area.

Job Description

  • Physically meet the members where they are to gain deep understanding of their situation and needs
  • Problem solve member’s problems and needs: clinical, psychosocial, financial and environmental.
  • Screen members according to MetroPlus Health Plan policies and procedures, assisting members to identify appropriate support activities and services to maximize health and wellness.
  • Facilitate home visits for Care Managers, provide telephonic care coordination for members that refuse home visits and conduct moderate to low touch visits follow-up visits as directed by Care Manager and/or Team Leader.
  • Provide services to members of varying age, clinical scenario, culture, financial means, social support, and motivation.
  • Engage members in a collaborative relationship, empowering them to manage their physical, psychosocial and environmental health to improve and maintain lifelong well-being.
  • Identify risks and gaps in care.
  • Maximize member’s access to available resources.
  • Work with member, caregivers, and health care providers to support the members plan of care integrating concepts of cultural sensitivity and privacy practices.
  • Promote communication, both internally and externally to enhance effectiveness of clinical and non- clinical services and overall care management services.
  • Assist members in understanding mechanics and management of health care and social support networks.
  • Provide care coordination including but not limited to; insuring access to care, reducing unnecessary hospitalizations, and appropriately referring to community supports.
  • Advocate for members by assisting them to address challenges and make informed choices.
  • Consult with Care Manger and/or Team Leader regarding clinical status and treatment options for members.
  • Develop collaborative relationships with clinical providers and facility staff.
  • Employ critical thinking and judgment when dealing with unplanned issues.
  • Maintain accurate, comprehensive documentation of required information in compliance with risk management, regulatory and accreditation requirements
  • Collect and prepare data, statistics, proposals and reports relevant to responsibility as a Personal Health Coach.
  • Comply with all orientation requirements, annual and other mandatory trainings, organizational and departmental policies and procedures, and actively participate in evaluation process.
  • Participate in case conferences and departmental meetings.
  • Maintain professional competencies as a Personal Health Coach.
  • Other duties as assigned by Manager.

Minimum Qualifications

  • BA in Social Work required. 
  • An equivalent combination of training, educational background and experience in related fields and educational disciplines. Prior experience in Case Management in a health care and/or Managed Care setting strongly preferred. 
  • Proficiency with computers navigating in multiple systems and web based applications. 
  • Confident, autonomous, solution driven, detail oriented, high standards of excellence, nonjudgmental, diplomatic, resourceful, intuitive, dedicated, resilient and proactive. 
  • Strong verbal and written communication skills including motivational coaching, influencing and negotiation abilities. 
  • Time management and organizational skills. 
  • Strong problem- solving skills. 
  • Ability to prioritize and manage changing priorities under pressure 
  • Must know how to use Microsoft Office applications including Word, Excel, and PowerPoint and Outlook. 
  • Ability to proficiently read and interpret medical records, claims data, pharmacy and lab reports, and prescriptions required. 
  • Ability to travel within the MetroPlus service area making home visits to members, facility visits to clinical providers, and visits to community, faith and other social service based agencies. 
  • Ability to work closely with member and caregiver. 
  • Ability to form effective working relationships with a wide range of individuals. 

Professional Competencies

  • Integrity and Trust
  • Customer Focus
  • Functional/Technical skills
  • Written/Oral Communication