BH Care Management Associate

BH Care Management Associate

Job Ref: 123544
Category: Utilization Review and Case Management
Department: BEHAVIORAL HEALTH HARP
Location: 50 Water Street, 7th Floor, New York, NY 10004
Job Type: Regular
Employment Type: Full-Time
Hire In Rate: $50,000.00
Salary Range: $50,000.00 - $50,000.00

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.

About NYC Health + Hospitals

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 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 BH Care Management Associate (CMA), under the direction of the BH CMA Supervisor, is responsible for the daily activities of the member case intake functions and associated workflow, as well as for performing other duties associated with the coordination of member care as outlined for the Core Behavioral Health and Harp Teams.The BH CMA is responsible for assisting the BH Care Managers with non-clinical activities such as creating cases and events; providing telephonic outreach to members, providers and community based organizations; handling member mailings; faxing clinical requests and individual Care Plans on behalf of the BH team.

Job Description

Handles calls to and from members to assist with benefits questions/issues and help schedule necessary medical appointments as identified by CM staff and/or member

Receives incoming calls from the Behavioral Health (BH) Automatic Call Distribution (ACD) line, conducting warm transfers between members and the clinical behavioral health case manager

Manages calls to and from providers regarding both inpatient and outpatient BH authorizations, HCBS referrals, specialty (PCP) visits, tests, and faxed care plans

Liaison between MetroPlusHealth and HHA/PCA vendors re: communication about service to members

Attach incoming Health Home Plans of Care to members chart and send notification task to appropriate BH queue in DCMS

Enter prior approvals in the authorization System (CareConnect).

Use CareConnect system to enter authorization or services as per benefit of the program.

Notifies vendors of the start date of the services to member

Notifies vendors of end of or cancellation of services for member

Monitors the assigned queues in the authorization system (Care Connect) to ensure timely processing of service authorization requests

Tracks and monitors key information identified by the Team Lead for quality purposes

Track and monitor members’ admission to hospitals, nursing home facilities, ER visits and unexpected outcomes

Track and monitor members’ documentation required for authorization and re-authorization of Personal Care Services. This includes coordinating the completion of Doctor’s orders or M11qs

Print and mail Home Health Aide/Personal Care Aide Plan of Care

Track member’s short-term absence from geographic areas

Notifies Care Manager if a member cannot be contacted

Documents Health Home calls in the absence of assigned primary BH CM; informs TL about such calls and the need for future follow up within one business day

Complete missing information from documentation received

Timely communicates member issues or needs and monitors screening of members effectively to improve quality and cost outcomes

All other tasks assigned by the Team Lead or the Behavioral Health management team

Minimum Qualifications

Minimum Qualifications

High School graduation or evidence of having satisfactory passed a High School Equivalency Program; and

One year of satisfactory full-time professional work experience

Demonstrated ability to accurately document calls into a computer system

Understanding of Medical terminology preferred

Knowledge of Health Homes and HCBS preferred

Prior managed care experience preferred

Prior experience in healthcare customer services and/or case management preferred

Language Preferences-Spanish, Mandarin, Cantonese, Russian, French, Creole

Professional Competencies

Integrity and Trust

Teamwork and Problem Solving

Customer Service Focus

Basic Microsoft Word, Teams and Excel skills

Written/Oral Communications