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Harp Care Manager

hace 1 mes

Arroyo, Puerto Rico Metroplus Health Plan A tiempo completo
Job Title: Harp Care Manager

At MetroPlus Health Plan, we are committed to empowering New Yorkers by uniting communities through care. We believe that healthcare is a right, not a privilege. If you have compassion and a collaborative spirit, we invite you to join our team.

Job Summary:

The Harp Care Manager develops, facilitates, and communicates a plan of care in partnership with the member, their assigned Health Home, primary caregiver, the primary and attending physicians, and various Behavioral Health and/or substance use disorder providers.

Key Responsibilities:
  • Clinically assess members for acute behavioral and physical health needs.
  • Generate referrals to providers, community-based resources, and appropriate services to assist in goal achievement.
  • Conduct Utilization Review for designated Case Management members for some diversionary levels of care.
  • Meet with members in their homes, shelters, other residential settings, at community agencies, hospital inpatient units, and/or day hospital programs.
  • Develop a formal plan of care for all services needed for the Harp member.
  • Notify physicians for any changes in member's plan of care.
  • Assist members and providers in accessing post-discharge aftercare related appointments.
  • Work with inpatient facility team to identify appropriate follow-up care for CORE and Harp BH members.
  • Responsible for outreaching members regarding adhering to 7-day follow-up appointment to offer a 30-day appointment as part of HEDIS measures.
  • Responsible for mailing discharge aftercare letters with a list of referrals to members not reached by phone.
  • Collaborate timely follow-up with assigned nurses for clinical updates to plans of care.
  • Document IDT care coordination notes between both internal MetroPlusHealth staff and external Health Home/CMA workers.
  • Review and Approve submitted Health Home Plans of Care and ensure that CMA's are conducting timely annual assessments.
  • Review and approve CORE/HCBS requests; educating CMA workers about PROS and IOP options for members who opt out of receiving CORE/HCBS.
  • Assist providers with achieving pay for performance goals and examine the feasibility of Value-Based Payment with high-volume providers for Harp line of business.
  • Educate providers on medication and treatment compliance while also promoting the use of Long-Acting Injectables.
  • Enlist existing provider network in promoting first-episode psychosis treatment.
  • Educate providers to alternate treatment services being promoted by Health + Hospitals in lieu of Inpatient Detox Attends.
  • Attends and prepares for bi-Weekly Interdisciplinary Care Team (ICT) meetings which will feature newly enrolled, frequently admitted, high-utilizing at-risk Harp members.
  • Oversee the coordination and delivery of comprehensive, quality healthcare and services for all members requiring care management in a cost-effective manner.
  • Evaluate housing needs appropriately and assist with housing application process.
  • Collaborating timely with MetroPlusHealth internal housing team for supportive assistance.
  • Assist members with the coordination of services from various settings as appropriate.
  • Including facilitating discharge from acute setting and alternate settings.
  • Provides Care Coordination throughout the continuum of care.
  • Optimizes both the quality of care and the quality of life for the MetroPlusHealth members.
  • Identifies members appropriate for specialty programs.
  • Documents in a comprehensive manner to ensure that all goals, interventions, and care coordination activities for each member in DCMS (EMR) system, and other applicable software programs, are compliant with professional standards and regulatory guidelines.
  • Contributes to MetroPlusHealth corporate goals through ongoing execution of member care plans and member goal achievement.
  • Performs other appropriate Harp Behavioral Health duties and participates in other special projects as assigned, including, but not limited to, audit review and preparation, quality improvement, community health education, facility/provider relations, and marketing activities.
Requirements:
  • Master's Degree required.
  • Overall, 3-5 years of Behavioral Health (Serious Mental Illness & Substance Use Disorder) experience in a managed care and/or in a Psychiatric Hospital Inpatient and/or Outpatient experience with both case and utilization management.
  • One-year Harp experience preferred.
  • Field-based Case Management Experience within the Integrated Collaborative Care Model Approach.
  • Experience with chronic condition management, particularly Diabetes, HIV, Heart Disease.
  • Pharmacy, Psyckes, E-Paces, HCS (UAS) MAPP, CORE/HCBS, Microsoft Teams Video knowledge.
  • Strong interpersonal and assessment skills, the ability to remain calm and poised with challenging members who often present as in a constant state of crisis.
  • Previous history of conducting home visits to members as well as assessing them bedside during an inpatient hospitalization or at their long-term Substance Abuse Residential setting.
  • Medical Background & Bilingual preferred.
  • Previous Quality Management liaison experience with hospitals and other large-volume providers to address cost, as well as HEDIS/QARR quality performance, preferred.
  • Licensure and/or Certification Required: Current valid unrestricted NY State License as LCSW, LMSW, LMHC.
Professional Competencies:
  • Integrity and Trust.
  • Teamwork and Problem-Solving Attitude.
  • Customer Service.
  • Member FIRST Focus.
  • Superior Technical Computer skills (Microsoft Office, DCMS, Teams Video Application).
  • Clear and Concise Written/Oral Communications.
  • Exceptional Organizational and Communication Skills.