MetroPlus Case Manager I

About the role

MetroPlusHealth is a healthcare provider serving residents of Bronx, Brooklyn, Manhattan, Queens, and Staten Island. The MetroPlusCase Manager I position focuses on promoting health and wellness for HIV-positive, homeless, and transgender members through individualized care plans.

Responsibilities

• Provides telephonic and/or face-to-face care management services to members at designated HIV primary care facilities, including care coordination, transition of care, out-patient follow-up, and ancillary service review.
• Develops and implements an individualized member Plan of Care utilizing various resources, including member, family care giver, primary care provider, and facility-based or community-based care manager.
• Promotes access to and oversees the coordination and delivery of comprehensive, quality healthcare services for HIV-positive, transgender, and homeless members.
• Communicates with the member’s primary care provider, community case manager, and all other applicable providers, vendors, or agencies to facilitate the health and wellness of the member in a coordinated and comprehensive manner.
• Identifies service utilization trends and potential member needs through review of encounter data, pharmacy/prescription data, completed member health assessment tools.
• Ensures that goals, interventions, and care coordination activities for each member are documented in the electronic health record in compliance with professional standards and regulatory guidelines.
• Mentors and supports the work of HIV Services Health & Wellness Advisors (Level 1) on their assigned team and other teams when requested.
• Attends and prepares for periodic departmental case conferences as assigned.
• Assists other MetroPlusHealth departments with resolution of member concerns related to retention, utilization management, quality management, customer service, and provider relations.
• Attends approved in-service and external education and training as per department directives.
• Performs, as assigned, other special projects and activities, including, but not limited to, audit review and preparation, quality improvement, community health education, facility/provider relations, and health plan promotion.
• Ensures that coordination of care activities for assigned caseload is compliant with Federal, State, and City regulations, and is consistent with the Mission, Vision and Values of the organization.

Requirements

• A Master’s degree from an accredited college or university in Social Work is required.
• A minimum of two years of clinical experience in HIV care or support systems that includes experience in care coordination, health education, and case management.
• A minimum of two years of experience in managed care is preferred.
• Computer literacy with proficiency with Microsoft Office products is required.
• Bilingual (English/Spanish) is preferred. Fluency in other languages is welcomed.
• A valid New York State license and current registration to practice as a Licensed Mental Health Counselor (LMHC), Licensed Master Social Worker (LMSW), or Licensed Clinical Social Worker (LCSW) is required.

Qualifications

• Integrity and Trust
• Customer Focus
• Functional/Technical Skills
• Excellent interpersonal, organizational communication, and analytical skills
• Computer literacy with proficiency with Microsoft Office products is required