Job Ref: 131588
Category: Utilization Review and Case Management
Department: PARTNERSHIP IN CARE
Location: 50 Water Street, 7th Floor,
New York,
NY 10004
Job Type: Regular
Employment Type: Full-Time
Salary Range: $55,000.00 - $55,000.00
MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day.
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.
Position Overview:
Empower. Unite. Care.
MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day.
With the support of the Health & Wellness Advisor II, the Health & Wellness Advisor I ensures the promotion of health and wellness among HIV-positive members and other members at high-risk for HIV by conducting high-volume outreach to assess their health and psychosocial needs and support them to stay in care and adherent to medication. The Health & Wellness Advisor I works in conjunction with the Health & Wellness Advisor II and other colleagues in a team-oriented approach with a focus on establishing member rapport.
9:00 AM- 5:00 PM
Promotes access to and oversees the coordination and delivery of comprehensive, quality healthcare services for members who are living with HIV, transgender, and homeless.
Performs telephonic care management activities including assessment, plan of care development, care coordination, out-patient follow-up, and ancillary service review to ensure optimum health outcomes.
Develops and implements an individualized, member-centered Plan of Care through direct telephonic and face-to-face member engagement, and inclusion, where appropriate, of collateral contacts including family members (with appropriate consent of the member), primary care provider, and other community and case managers to identify and address the needs and barriers of members living with HIV (and others in the Special Needs Plan) to promote the health and wellness of the member.
Provides health education using coaching and motivational interviewing techniques to promote improved health outcomes for HIV engagement in care and viral load suppression, engagement with behavioral health and substance use services and effective management of other co-morbid illnesses, such as hepatitis C, diabetes, hypertension, and asthma/COPD.
Participates in special outreach and quality improvement projects as assigned.
Documents all care management activities for each member and ensures that such documentation is in compliance with professional standards and regulatory guidelines using the correct templates.
Addresses member primary care provider assignment during outreach and reassigns members as appropriate.
Carefully follows designated departmental compliance, care management, and quality improvement and workflows as assigned.
Escalates cases and issues to their supervisor as appropriate.
Answers calls on the in-bound call center telephone line in a professional and timely manner.
Attends and prepares for case conferences, including Medicare interdisciplinary case conference and conferences on special topics and/or with other departments.
Orients assigned new members to MetroPlusHealth and the scope of services the plan provides as needed.
Ensures that coordination of membership enrolled in all lines of business is compliant with Federal, State, and City regulations, and are consistent with the Mission, Vision, and Values of the organization.
Bachelor’s degree from an accredited college or university in a healthcare-related field is required. Master’s degree is preferred.
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. Managed care experience is preferred.
Professional Competencies:
Integrity and Trust
Customer Focus
Functional/Technical Skills
Written/Oral Communications
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