Care Manager SW (Medicare)

Care Manager SW (Medicare)

Job Ref: TE0201
Category: Utilization Review and Case Management
Department: CASE MANAGEMENT PROGRAM
Location: 50 Water Street, 7th Floor, New York, NY 10004
Job Type: Regular
Employment Type: Full-Time
Work Arrangement: Hybrid
Salary Range: $85,000.00 - $85,000.00

Position Overview

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 member’s needs, environment, providers, support system and optimization of services available to them. The Care Manager is expected to assess and evaluate members’ needs, and be a creative, efficient, and resourceful problem solver. The Care Manager is monitored and assessed based on value added to improved health status of members. That includes, but not limited to their disease management physical and behavioral, medication adherence, and utilization of emergency services, hospitalizations, and avoidable complications. The Care Manager’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 clinical, social, financial, environmental and safety aspects.

Scope of Role & Responsibilities:

Physically meet the members where they are to gain deep understanding of their situation and needs

Problem solves member’s problems and needs: clinical, psychosocial, financial, environmental

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

Assess risks and gaps in care

Maximize member’s access to available resources

Prepare member-oriented plan of care with member, caregivers, and health care providers, integrating concepts of cultural sensitivity and privacy practices

Communicate plan of care to Primary Care Physician initially and no less than monthly with updates

Ensure member caregiver understanding as it relates to language barriers, stress reaction or cognitive limitations/barriers using verbal and nonverbal techniques

Train member on relevant chronic diseases, preventive care, medication management (medication adherence), home safety, etc.

Provide Complex care management 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 regarding clinical status and treatment options

Develop collaborative relationships with clinical providers and facility staff

Employ critical thinking and judgment when dealing with unplanned issues

Ability to use data as a tool in tracking and trending outcomes and clinical information

Maintain accurate, comprehensive, and current clinical and non-clinical documents

Comply with all orientation requirements, annual and other mandatory trainings, organizational and departmental policies, and procedures, and actively participate in evaluation process

Maintain professional competencies as a Care Manager

Other duties as assigned by Team Lead and Manager.

Required Education, Training & Professional Experience:

Master’s Degree required

Minimum 3 years’ 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

Ability to proficiently read and interpret medical records, claims data, pharmacy and lab reports, and prescriptions required

Ability to travel within the MetroPlusHealth 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.

Licensure and/or Certification Required:

A valid license and current registration to practice as a Licensed Master Social Worker (LMSW) or Licensed Clinical Social Worker (LCSW) issued by the New York State Education Department (NYSED).

Professional Competencies:

Integrity and Trust

Customer Focus

Functional/Technical Skills

Written/Oral Communications

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 form effective working relationships with a wide range of individuals.

#MPH50

#LI-Hybrid