Job Ref: 133951
Category: Utilization Review and Case Management
Department: CASE MANAGEMENT
Location: 50 Water Street, 7th Floor,
New York,
NY 10004
Job Type: Regular
Employment Type: Full-Time
Salary Range: $83,000.00 - $83,000.00
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.
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's network includes over 27,000 primary care providers, specialists and participating clinics. For more than 40 years, MetroPlusHealth has been committed to building strong relationships with its members and providers.
The primary goal of the Care Manager 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 members’ needs, environment, providers, support system and optimization of services available to them. Care Manager is expected to assess and evaluate member’s needs, be a creative, efficient, and resourceful problem solver. In collaboration with the members’ care team, a plan of care with individualized goals and interventions is developed, implemented and evaluated outcomes.
9:00 A.M – 5:00 P.M
Purpose of Position:
This class of positions encompasses professional, supervisory or administrative work of varying degrees of difficulty and responsibility in the operation of a social work department providing psychosocial and other social work services to different types of patients across various settings. Ensures patient-centered quality care and services in support of better outcomes and improved patient experience, in accordance with all applicable local, state, and federal rules and regulations, and social work standards of care. All personnel perform related work.
Under direct supervision, with limited latitude for independent judgment and decision-making, performs the following typical tasks:
Examples of Typical Tasks:
1. Screens charts for historical and clinical information, conducts psychosocial evaluations through interviews with patients and/or identified surrogates and formulates appropriate social work treatment plans.
2. Works within health care setting offices or in community settings within NYC to provide individual and group counseling, as well as concrete social services, as required.
3. Confers and consults with professionals in other disciplines to determine and implement a multidisciplinary approach to patient care and to develop treatment plans, evaluate patients’ progress, develop discharge and aftercare plans and recommend alternative action or treatment.
4. Provides outreach services, makes referrals to other governmental, public and/or community agencies, prepares patients to accept services, provides direct social work services on high-risk cases and may escort patients in connection with community activities and referrals, as needed.
5. As a mandated reporter, documents and reports suspected cases of child abuse or neglect to the New York State Central Registry.
6. Appears and testifies at administrative and court hearings, as necessary.
7. Assists in plans for institutional or hospital discharge and other post institutional/hospital care; evaluates alternate care arrangements for patients, where needed.
8. Participates in staff conferences and other related social work meetings, special studies, committees and/or research projects and internal/external quality assurance/performance improvement (QA/PI) activities, programs, and trainings, as required.
9. Prepares reports and related paperwork; keeps appropriate records.
10. Ensures ongoing compliance with NYC Health + Hospitals policies and procedures with national standards and other applicable external regulatory requirements, guidelines, and accreditation authorities, as well as safety and quality management standards.
11. May assist in the provision of clinical services only under supervision of a New York State LCSW, licensed psychologist, or psychiatrist.
12. Performs other related duties, as directed and with required supervision.
1. One (1) year of experience in case management, care coordination, discharge planning, utilization management/review, quality assurance/management, or a closely related area in a health or managed care setting; and a doctoral degree in Psychology or a related discipline from an accredited college or university, or one of the following may be substituted for a doctoral degree:
a. A valid Credentialed Alcoholism and Substance Abuse Counselor (CASAC) Level I, Level II, Advanced, or Master issued by the NYS Office of Addiction Services and Supports (OASAS).
b. A valid license and current registration to practice as a Licensed Mental Health Counselor (LMHC), Licensed Master Social Worker (LMSW), or Licensed Clinical Social Worker (LCSW) issued by the New York State Education Department (NYSED).
2. Positions supporting behavioral health, Health and Recovery Plan (HARP), and children’s special services functions require three (3) years of experience, as described in 1. above, and a valid license and current registration to practice as a Licensed Mental Health Counselor (LMHC), Licensed Marriage and Family Therapist (LMFT), Licensed Master Social Worker (LMSW), or Licensed Clinical Social Worker (LCSW) issued by the New York State Education Department (NYSED).
NYC Health and Hospitals offers a competitive benefits package that includes:
Comprehensive Health Benefits for employees hired to work 20+ hrs. per week
Retirement Savings and Pension Plans
Paid Holidays and Vacation in accordance with employees' Collectively bargained contracts
Loan Forgiveness Programs for eligible employees
College tuition discounts and professional development opportunities
College Savings Program
Union Benefits for eligible titles
Multiple employee discounts programs
Commuter Benefits Programs
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