Children's Behavioral Health Care Manager

MetroPlusHealth, a wholly‑owned subsidiary of NYC Health + Hospitals, provides a broad range of health‑care services across Bronx, Brooklyn, Manhattan, Queens, and Staten Island. Our mission is to empower New Yorkers by connecting communities through comprehensive care. Position Overview The Children’s Behavioral Health Care Manager (BH CM) works in the Children’s Special Services Department and provides a hybrid approach—utilization and case management—to support members aged 0‑21 with complex behavioral, medical, and/or developmental health issues. Responsibilities Conduct utilization and quality management activities in accordance with New York State and MetroPlusHealth Utilization Management policies for services including HCBS, AOT, and PROS. Review and approve Plans of Care and HCBS services in collaboration with CSS Medical CMs and the Foster Care Liaison. Collaborate with Health Home Coordinators, LDSS/VCFA, and community providers to advocate for appropriate access to comprehensive services. Perform telephonic reviews for diversionary and outpatient services using NYS HCBS criteria. Contribute to UM program goals by containing health‑care costs and promoting diversionary services to avoid unnecessary admissions, maintaining a high‑quality medical delivery system. Collect all pertinent clinical information and document it within the organization’s care and utilization management system. Promote alternative care programs, research available options—including eligibility for waivers—and consider costs and appropriateness of patient placement in collaboration with the health plan. Communicate with the Medical Director regarding outpatient/diversionary requests that do not meet medical necessity or appropriate level of care, as well as out‑of‑network transfer issues. Recommend, coordinate, and educate providers about alternative care options, including medication and treatment compliance and the use of long‑acting injectables. Engage existing provider networks in the promotion of first‑episode psychosis treatment. Instruct providers on alternative treatment services promoted by Health + Hospitals in lieu of inpatient detoxification. Attend and prepare for Integrated Clinical Rounds meetings focused on newly enrolled, frequently admitted, and high‑utilizing at‑risk children/youth. Assure continuity of care for all admitted members through collaboration with BH UM CM, early discharge planning, and coordination with hospital Social Work, Health Homes, and community providers. Identify potentially catastrophic, high‑risk medical and behavioral cases and Transitioning Aged Youth (TAY), and coordinate with Children’s Nurse CM and Foster Care Liaison to provide an integrated approach to case management. Communicate all potential quality‑of‑care concerns to the Director in a timely manner. Contribute to MetroPlusHealth corporate goals by participating in team activities, offering input and assistance with the development and delivery of education and training. Perform other BH UM/CM duties as assigned by the Medical Director, Director of Children’s Special Services, or BH HARP Department Management, and participate in special projects such as monthly audit review, quality improvement initiatives, community health education, and facility/provider relations. Promote a multigenerational approach to care management and provide education, referrals, and coaching to families to foster a supportive environment. Provide telephone triage and crisis intervention to callers and, when necessary, assist members in accessing local services and resources. Minimum Qualifications Master’s Degree in Social Work or Mental Health Counseling. Minimum 3 years of behavioral‑health experience in managed‑care utilization review, quality assurance, and discharge planning (preferably in a psychiatric inpatient and/or outpatient setting). Experience managing care for children/youth, including high‑risk groups such as children with or at risk for substance use disorder, co‑occurring major mental disorders, and involvement in multiple service systems. Knowledge of New York State child‑serving systems; experience working with community and family‑based services preferred. Previous experience within an Integrated Collaborative Care Model approach preferred. Knowledge and experience in children’s physical health, behavioral‑health services, Early and Periodic Screening, Diagnostic and Treatment (EPSDT) services, and social‑service programs such as Health Homes, OPWDD, and OCFS preferred. Experience with chronic‑condition management, particularly asthma, diabetes, HIV, and heart disease. Knowledge of psychopharmacology, E‑Paces, InterQual, Locus/Calocus, HCS (UAS) MAPP preferred. Strong interpersonal and assessment skills, with the ability to remain calm and poised with challenging providers. Medical background and bilingualism preferred. Previous experience with hospitals and large‑volume providers to address HEDIS/QARR initiatives preferred. Licensure And/or Certification Required 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. Professional Competencies Integrity and trust Teamwork and problem‑solving attitude Clinical skills and subject‑matter knowledge Ability to learn and master UM/CM MetroPlusHealth systems and procedures, Microsoft Office, virtual‑meeting applications, and related procedures Excellent customer service Clear and concise oral and written communication skills Strong interpersonal and assessment skills, with the ability to remain calm and poised with challenging providers MetroPlusHealth is an equal opportunity employer. All qualified applicants are encouraged to apply. #J-18808-Ljbffr MetroPlusHealth