MetroPlus Health 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, MetroPlus Health network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlus Health has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.

Position Overview

The HARP Care Manager develops, facilitates, and communicates a plan of care in partnership with the member, his/her assigned Health Home, primary caregiver, the primary and attending physicians, and various Behavioral Health and/or Substance Use Disorder providers. In partnership with these parties, the HARP Care Manager assesses, plans, facilitates, and advocates for options and services to meet a HARP member's complex health needs through communication and available resources. In addition, the HARP Care Manager is responsible for scheduling aftercare follow-up for members discharging from an acute behavioral health inpatient setting. This position ensures that members have a scheduled appointment in place, completes follow-up and reminder call to member and follows up with providers to ensure member's compliance with aftercare. This position requires that most case management activities will be performed in field via community and facilities outreach.

• Clinically assess members for acute behavioral and physical health needs. Generating referrals to providers, community-based resources, and appropriate services and other resources to assist in goal achievement.
• Conduct Utilization Review for designated Case Management members for some diversionary levels of care. (CORE/HCBS, ACT).
• Expected to meet with members in their homes, shelters, other residential settings, at community agencies, hospital inpatient units and/or day hospital programs.
• Conduct initial and ongoing Behavioral Health clinical assessments.
• 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.
• Assists members and providers in accessing post-discharge aftercare related appointments. Works 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 MetroPlus Health 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 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 MetroPlus Health 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 MetroPlus Health 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 complaint with professional standards and regulatory guidelines.
• Contributes to MetroPlus Health 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.

• 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.