MetroPlus Case Manager Lvl

MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlusHealth's network includes over 27,000 primary care providers, specialists and participating clinics. For more than 40 years, MetroPlusHealth has been committed to building strong relationships with its members and providers.Purpose of Position:Under direction, optimizes members' quality of care, their care experience, and cost savings through theassessment and evaluation of members' needs and circumstances; enhanced engagement and improvedaccess to resources; and appropriate utilization and quality management. Serves as a member advocate,accompanying and providing comprehensive planning and support for members throughout their care journey,from members' homes to health care and community settings and other relevant locations. Manages medicalcosts through timely prospective, concurrent, and retrospective review and research activities, and ensurescompliance with all relevant laws, rules, policies, procedures, and standards of care.Work Shifts9:00 A.M - 5:00 P.MDuties & ResponsibilitiesAssignment Level IUnder direction, with significant latitude for independent judgement and decision making, performs assignedduties related to assessing members' clinical, social, financial, environmental and/or safety needs; addressingmember challenges/issues; facilitating and monitoring members' care progress; and managing costs.Essential Duties and Responsibilities:1. Travels to and meets with members of varying ages, clinical scenarios, cultures, financial means, socialsupports, and motivations to gain in-depth understanding of their situations, including conducting initial andongoing clinical assessments.2. Prepares evidence-based, member-oriented plans of care with members, caregivers, and health careproviders; appropriately integrates principles of cultural sensitivity, high-touch care, and privacy; and regularlycommunicates plans of care updates to Primary Care Physicians and other providers.3. Supports appropriate care coordination across the continuum of care by conducting telephonic and in-personmember outreach activities, assisting members with the coordination of services from various settings, andgenerating referrals to providers, community-based services, and other resources.4. Researches available care options, while carefully considering appropriateness and costs, and promotingalternative care programs/treatment services, when practicable.5. Assesses risks and gaps in care, and works collaboratively with clinical providers and others to maximizeaccess to available resources and resolve problems related to members' clinical, psychosocial, financial, andenvironmental needs.6. Educates members and caregivers on relevant topics, including chronic diseases, preventive care, riskreduction, medication adherence/management, and home safety; and may be responsible for researchingand educating providers on medication and treatment compliance and alternative care options.7. Promotes and facilitates a multidisciplinary approach, supporting collaboration and coordinated careoperations between clinical and non-clinical areas and various operating departments and programs.8. Advocates for and engages members in a collaborative relationship, assisting them to address challengesand make informed choices regarding clinical statuses and treatment options, and empowering them tomanage their physical, psychosocial, and environmental health.9. Communicates directly with providers/designees, when appropriate, to gather all clinical information neededto determine the medical necessity of requested services; consults with Medical Director concerning casesthat do not meet medical necessity or appropriate level(s) of care.10. Provides complex case management, including but not limited to ensuring access to care, reducingunnecessary hospitalizations, and appropriately referring to community supports.11. Identifies potentially high-risk and fragile medical and behavioral cases, and coordinates with superiors colleagues to provide an integrated approach to case management.12. Ensures continuity of care by appropriately communicating information concerning follow-up appointmentsand discharge aftercare, identifying barriers to discharge planning, and working collaboratively with otherdepartments/teams, members, providers, and other health care setting staff to remove identified barriers.13. Maintains accurate, comprehensive and current clinical and non-clinical documentation, and ensures thatgoals, interventions, and care coordination and case management activities for each member aredocumented in the electronic health record.14. Tracks and trends outcomes and other clinical data, and presents statistics and advice on trends in internaldepartmental meetings and in other forums, as necessary.15. Performs other related duties, as assigned.Minimum Qualifications1. One (1) year of experience in case management, care coordination, discharge planning, utilization management/review, quality assurance/management, or a closely related area in a health or managed care setting; and a doctoral degree in Psychology or a related discipline from an accredited college or university, or one of the following may be substituted for a doctoral degree:a. A valid Credentialed Alcoholism and Substance Abuse Counselor (CASAC) Level I, Level II, Advanced, or Master issued by the NYS Office of Addiction Services and Supports (OASAS).b. A valid license and current registration to practice as a Licensed Mental Health Counselor (LMHC), Licensed Master Social Worker (LMSW), or Licensed Clinical Social Worker (LCSW) issued by the New York State Education Department (NYSED).2. Positions supporting behavioral health, Health and Recovery Plan (HARP), and children's special services functions require three (3) years of experience, as described in 1. above, and 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 (NYSED).BenefitsNYC Health and Hospitals offers a competitive benefits package that includes:Comprehensive Health Benefits for employees hired to work 20+ hrs. per weekRetirement Savings and Pension PlansPaid Holidays and Vacation in accordance with employees' Collectively bargained contractsLoan Forgiveness Programs for eligible employeesCollege tuition discounts and professional development opportunitiesCollege Savings Program Union Benefits for eligible titles Multiple employee discounts programsCommuter Benefits Programs

Created: 2026-04-02