Children's Care Manager (RN)

About the role

MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We provide high-quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens, and Staten Island through various Medicaid, Medicare, and managed care programs. As a subsidiary of NYC Health + Hospitals, MetroPlusHealth operates over 27,000 primary care providers and clinics.

Responsibilities

• Coordinates with Health Home Coordinators and LDSS/VFCA Care Managers to ensure patient comprehensive treatment needs are met.
• Coordinates member’s service needs with community agencies.
• Provides education and coaching to members' family.
• Conducts follow-up quarterly assessment calls to Health Home Coordinators.
• Provides clinical guidance and support to assist members with achieving their goals.
• Has extensive knowledge of community resources/services.
• Prepares for and participates in all clinical rounds.
• Interacts with physicians and other members of the Providers’ Clinical Teams for discharge planning and required DME.
• Collaborates with UM team to determine appropriate level of care.
• Consults with Clinical Peer Reviewers on requests for services that do not meet medical necessity criteria.
• Communicates with Clinical Peer Reviewers about clinical/authorization questions, alternative treatment options, and concerns regarding specific cases.
• Shares information with members' families, Health Home coordinators, LDSS/VFCA, clinical and HCBS providers regarding medical benefits.
• Provides telephone triage and crisis intervention to callers and ensures members have access to local services and resources.
• Recognizes quality of care issues and reports them appropriately through internal and external processes.
• Performs other duties as assigned by Medical Director for Medically Fragile Children, Senior Director of Children’s Special Services, and the Director of Children’s Special Services.

Requirements

• A minimum of a Bachelor’s Degree required.
• A minimum of two years’ clinical experience in an acute care setting.
• Experience using InterQual Guidelines required.
• Knowledge of medical care and HCBS services needed by medically fragile children.

Qualifications

• A valid New York State license and current registration to practice as a Registered Professional Nurse (RN) issued by the New York State Education Department (NYSED).

Skills

• Clinical skills and subject matter knowledge.
• Ability to learn and master UM/CM MetroPlusHealth systems and procedures.
• Customer Service.
• Oral and written communication skills.

Pay

$112,351.00 - $112,351.00

Schedule

9:00 AM - 5:00 PM