MetroPlus Case Manager I

Duties & 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 to ensure optimal health outcomes.
• Develops and implements an individualized member Plan of Care utilizing various resources, including, but not limited to member, family care giver, primary care provider, and facility-based or community-based care manager, focused on health coaching and care coordination activities, aligned with member needs and preferences in reaching their health goals.
• Promotes access to and oversees the coordination and delivery of comprehensive, quality healthcare services for HIV-positive, transgender, and homeless members.
• Provides health education and coaching on HIV disease, HIV primary and secondary risk reduction, and other chronic co-morbid illness, including, but not limited to hepatitis C, diabetes and hypertension as indicated by the Plan of Care.
• 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 and participates in the competency development of HIV Services Health & Wellness Advisors (Level 1).
• Attends and prepares for periodic departmental case conferences as assigned. Reviews, identifies, and assesses the member Plan of Care and recommends changes to promote the health and wellness of the member.
• Affords assistance to 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.

Minimum Qualifications

• 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.

Licensure and/or Certification Required

• 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.

Professional Competencies

• 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