HealthFirst

Compensation

Full Description

The Care Manager plans, manages and/or coordinates physical and/or behavioral care with members, collaborating with clinicians and health care team members. This role will support a variety of areas including the Recipient Restriction Program (RRP) for enrollees that have presented a pattern of abusing and misusing the Medicaid program, unsuppressed HIV+ members, hemophilia, and episodic engagement. The work with the RRP enrollees will include facilitating medical and psychosocial care and addressing identified member needs across the continuum of care. Other areas of care management support efforts will include complex care/rising risk members, involving product lines such as CompleteCare, SNP, Medicaid/Medicare, PHSP, HARP, etc. The Care Manager is responsible for applying care management principles when engaging members and addressing coordination of the member’s health care services. *Depending on one’s residence and line of business, the Care Manager may be expected to make home, nursing home, and other related sites visits around downstate New York. Duties/Responsibilities of the Restricted Recipient Program: Oversees the care management of members in the NYS RRP who require tightly managed access to medical services due to their historic misuse/abuse of Medicaid program resources. Conducts medical reviews of member usage patterns analyzing for fraud, waste or abuse trends to determine whether restrictions should be applied, remain or lifted as a result. Participates in RRP Committee meetings; presenting member updates as needed. Provides care management to high risk/cost and/or RRP Committee referred members, to improve health outcomes, coordination of benefits and SDOH, and/or members referred by families or providers. Attends Clinical Rounds with medical providers and interdisciplinary team. Provides programmatic case management to complex care/rising risk members including those who are HIV+ and viral load unsuppressed. Advocates, informs, and educates beneficiaries on services, self-management techniques, and health benefits. Conducts assessments to identify barriers and opportunities for intervention. Develops care plans that align with the physician’s treatment plans and recommends interventions that align with proposed goals. Generates referrals to providers, community-based resources, and appropriate services and other resources to assist in goal achievement. Collaborates with provider doctors, social workers, discharge planners, and community based service providers to coordinate care accordingly. Coordinates and facilitates with the multi-disciplinary health care team as necessary in order to ensure care plan goals are achieved and maximize member outcomes. Assists in identifying opportunities for alternative care options based on member needs and assessments. Evaluates service authorizations to ensure alignment and execution of the member’s care and physician treatment plan. Contributes to corporate goals through ongoing execution of member care plans and member goal achievement. Documents all encounters with providers, members, and vendors in the appropriate system in accordance with internal and established documentation procedures; follows up as needed; and updates care plans based on member needs, as appropriate. Occasional overtime as necessary. Additional duties as assigned. Minimum Qualifications: NYS RN Preferred Qualifications: Strong interpersonal and assessment skills, especially the ability to relate well with seniors, their families, and community care providers, along with demonstrated ability to handle rapidly changing crisis situations. Fluency in Spanish, Korean, Mandarin, or Cantonese. Knowledge and experience with the current community health practices for the frail adult population and cognitive impaired seniors. Knowledge of InterQual and LOCADTR. Experience managing member information in a shared network environment using paperless database modules and archival systems. Experience and knowledge of the relevant product line Relevant work experience preferably as a Care Manager Demonstrated ability to manage large caseloads and effectively work in a fast-paced environment Proficient with simultaneously navigating the Internet and multi-tasking with multiple electronic documentation systems Experience using Microsoft Excel with the ability to edit, search, sort/filter and other Microsoft and PHI systems WE ARE AN EQUAL OPPORTUNITY EMPLOYER. HF Management Services, LLC complies with all applicable laws and regulations. Applicants and employees are considered for positions and are evaluated without regard to race, color, creed, religion, sex, national origin, sexual orientation, pregnancy, age, disability, genetic information, domestic violence victim status, gender and/or gender identity or expression, military status, veteran status, citizenship or immigration status, height and weight, familial status, marital status, or unemployment status, as well as any other legally protected basis. HF Management Services, LLC shall not discriminate against any disabled employee or applicant in regard to any position for which the employee or applicant is otherwise qualified. If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to careers@Healthfirst.org or calling 212-519-1798 . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within HF Management Services, LLC will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with HF Management Services, LLC. Know Your Rights All hiring and recruitment at Healthfirst is transacted with a valid “@healthfirst.org” email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst. Healthfirst will never ask you for money during the recruitment or onboarding process. Hiring Range*: Greater New York City Area (NY, NJ, CT residents): $81,099 - $117,466 All Other Locations (within approved locations): $71,594 - $106,080 As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision. In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live. *The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role. Healthfirst is New York’s largest not-for-profit health insurer offering it’s nearly 1.7 million members access to high-quality, affordable healthcare. As part of the community for nearly 30 years, Healthfirst’s unique advantage is rooted in its belief that good health doesn’t start in a doctor’s office. The company’s mission is to put its members first by working closely with care providers and community leaders to address broader issues that can impact health and well-being. This value-based care model is the foundation of the company’s sustained growth in one of the most dynamic markets in the country. So, if you are passionate about what you do and want to work for a company that is focused on the future and dedicated to making a difference in people’s lives, then Healthfirst is for you. Click here to navigate back to the career site!