BH Care Manager

MetroPlus • City of Daşşak, NY, United States • $200k - $250k / year • 1w ago

Empower. Unite. Care.

MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day.

About NYC Health + Hospitals

MetroPlusHealth 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, MetroPlusHealth network includes over 27,000 primary care providers, specialists, and participating clinics. For more than 30 years, MetroPlusHealth has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.

Position Overview

The BH Care Manager develops, facilitates, and communicates a plan of care in partnership with the member, their assigned Health Home, primary caregiver, the primary and attending physicians, and various Behavioral Health and/or substance use disorder providers. This position collaborates with the aforementioned parties to assess, plan, facilitate, and advocate for options and services to meet a member’s behavioral health needs through communication and available resources.

Job Description

Clinically assess members for acute behavioral and physical health needs. Generate referrals to providers, community-based resources, and appropriate services to assist in goal achievement.
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 member.
Notify physicians of any changes in the member’s plan of care. Follow up with assigned nurses for clinical updates to plans of care.
Document IDT care coordination notes between both internal MetroPlusHealth staff and external BH providers and caregivers.
Attend and prepare for bi-Weekly Interdisciplinary Care Team (ICT) meetings featuring newly enrolled, frequently admitted, high-utilizing at-risk members.
Assist members with the coordination of services from various settings as appropriate, including facilitating discharge from acute settings and alternate settings.
Provide care coordination throughout the continuum of care. Optimize both the quality of care and the quality of life for the MetroPlus members.
Assist providers with achieving pay-for-performance goals and examine the feasibility of Value Based Payment with high volume providers for Mainstream Medicaid.
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.
Document comprehensively to ensure that all goals, interventions, and care coordination activities for each member in DCMS system, and other applicable software programs, are compliant with professional standards and regulatory guidelines.
Evaluate housing needs appropriately and assist with the housing application process, collaborating timely with MetroPlus internal housing team for supportive assistance.
Contribute to MetroPlus corporate goals through ongoing execution of member care plans and member goal achievement.
Perform other appropriate Behavioral Health Departmental duties and participate 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

Bachelor’s degree in healthcare or related field required.
3-5 years of Behavioral Health (Serious Mental Illness & Substance Use Disorder) experience, preferably in a Psychiatric Hospital Inpatient and/or Outpatient experience.
1-3 years of Behavioral Health Managed Care Case Management experience.
Working knowledge of NY State Health Home System and Plan of Care process.
Case Management Experience within the Integrated Collaborative Care Model Approach.
Strong interpersonal and assessment skills, with the ability to remain calm and poised with challenging members who often present 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.
Knowledge of Psyckes, E-Paces, HCS (UAS) MAPP, Microsoft Teams Video knowledge preferred.
Medical Background & Bilingual preferred.
Previous Quality Management liaison experience with hospitals and other large volume providers to address cost, as well as HEDIS/QARR quality performance, preferred.

Licensure and/or Certification Required: