Care Manager (Licensed Social Worker) - Integrated Case Management

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 30 years, MetroPlusHealth has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.

Position Overview

The Care Manager Level II is the experienced, role model, and efficient member of the Case Management Program team. The Care Manager II works hand and hand to provide support and assistance to Level 1 Care Managers when needed, acting as a preceptor in the Department. With the goal of optimizing members' health care and delivery of care experience and improving quality of care, Care Managers who are Level II are expected to work consistently to care for members, and lead by example. Care Managers Level II are expected to assess and evaluate member needs, be a creative, efficient, and resourceful problem solver. The Care Manager Level II should demonstrate a commitment to their own professional development by obtaining certifications, participating in case conferences and orientation, attending conferences, and identifying opportunities for continuous improvement of the Case Management program.

• Act as a preceptor for new hires within the ICM team
• Provide guidance to new hires or junior team members
• Care Manager Level II is expected to give a presentation on an annual basis based on research or studies that either support changes in carrying out the duties of a Care Manager, industry changes, or other methods or tactics to improve the efficiency and or quality of the services offered within the department.
• Address member problems and needs clinical, psychosocial, financial, environmental
• Provide services to members of varying age, risk level, clinical scenario, culture, financial means, social support, and motivation
• Engage members in a collaborative relationship, empowering them to self-manage their physical, psychosocial, and environmental health to improve and maintain lifelong well being
• Prepare member-oriented plan of care with member, caregivers, and health care providers, integrating concepts of cultural sensitivity and privacy practices
• Participate in interdisciplinary rounds
• Ensure plans of care have individualized goals and interventions
• Communicate plan of care to Primary Care Physician and other members of the care team, as applicable
• Address "gaps in care" with the member and provider
• Address members Social Determinants of Health issues
• Link members to available resources
• Provide care management support during Transitions of Care
• Ensure member/caregiver understanding as it relates to language barriers, stress reaction or cognitive limitations/barriers
• Train member on relevant chronic diseases, preventive care, medication management (medication reconciliation and/or adherence), home safety, etc.
• Provide Complex care management including but not limited to; ensuring access to care, reducing
• unnecessary hospitalizations, and appropriately referring to community supports
• Advocate for members by assisting them to address challenges and make informed choices regarding clinical status and treatment options
• Employ critical thinking and judgment when dealing with unplanned issues
• Maintain knowledge of chronic conditions and use job aids as a guidance
• Maintain accurate, comprehensive, and current clinical and non-clinical documentation in DCMS, the Care Management System
• Comply with all orientation requirements, annual and other mandatory trainings, organizational and departmental policies and procedures, and actively participate in evaluation process
• Maintain professional competencies as a Care Manager
• Other duties as assigned by leadership.

• Master's degree in social work required
• LMSW/LCSW with current NYS license
• Has been in the Care Manager Level 1 role for a minimum period of one (1) working within the Integrated Care Management this includes new hires and those that transfer from other areas of MetroPlusHealth
• Must meet all compliance requirements of Level 1 at 95% for at least ten (10) months over a twelve (12) month period
• Must meet performance goals, measured by quality and productivity.
• Must have a satisfactory attendance record
• Must not have any substantial Chart Audit tool short comings for a ten (10) out of the twelve (12) months preceding promotion
• Ability to proficiently read and interpret medical records, claims data, pharmacy, lab reports and prescriptions required
• If needed, ability to travel within the MetroPlusHealth service area to participate in facility visits, community events, home visits or other community meetings, including conferences.

Professional Competencies

• Customer Focus
• Functional/Technical skills
• Confident, autonomous, solution driven, detail oriented, high standards of excellence, nonjudgmental, diplomatic, resourceful, intuitive, dedicated, resilient and proactive.
• Strong verbal and written communication skills including motivational coaching, influencing and negotiation abilities
• Time management and organizational skills
• Strong problem-solving skills and ability to prioritize and manage changing priorities under pressure.

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