NYC Health Hospitals Care Management Associate in United States
MetroPlus provides access to health care services to New York City residents in Brooklyn, Queens, the Bronx and Manhattan through New York State's Medicaid Managed Care, Child Health Plus, Family Health Plus and Partnership in Care, an HIV Special Needs Program through its network of participating providers.
The Care Management Associate, under the direction of the Associate Director, is responsible for the daily activities of the member case intake functions and associated work flow, as well as for performing other duties associated with the coordination of member care as outlined and/or assigned by their Network Team U/CM Nurse.
- Receive requests from providers via Fax, phone and/or mail for Personal Care Services.
- Verify member eligibility and benefit using the Care Management System and/or epaces.
- Enter Personal Care Authorization requests and extension requests including any associated information into the system in order to generate a tracking number.
- Request clinical information and forms, including physician’s request for personal care services, and the nursing/social assessment form. Follow up with the nurse if forms are not received within the specified timeframe.
- Receive all written correspondence received for the team via or mail, and assign to the appropriate Personal Care Team Nurse for review.
- Refer those requests which require authorization and/or clinical review to the appropriate Utilization/Care Management Team Nurse or Case Manager according to assigned network, site or specialty.
- Generate approval letters for members and providers, where applicable, utilizing the system’s correspondence module, and selecting the correct template according to the members line of business.
- Receive in-coming calls, address the caller’s needs (providers and members) and/or offer clarification on questions or concerns as related to policy & procedure and benefits, and/or transfer or direct callers to appropriate parties as needed.
- Assist Team Nurse with requesting and obtaining information from personal care agencies and other providers.
- Assist Team Nurse co-worker with member calls to follow up on personal care management activities.
- Provide cross-coverage for co-workers on lunch and/or vacation.
- Assist other U/CM Nurses as directed.
- Participate in special projects as requested or required.
- Participate in on-going training and staff meetings to enhance job knowledge and skills, and to offer ideas towards the enhancement of the department’s processes.
- Participate in departmental quality improvement activities
- Perform other duties as assigned.
- High School graduation or evidence of having satisfactory passed a High School Equivalency Program.
- Prior managed care with customer service/call center experience preferred.
- Understanding of medical terminology including ICD-9 and CPT-4 codes preferred.
- Excellent data entry skills, proficiency with Microsoft Office Applications and ability to research on the Internet.
- Excellent organizational and communication skills.
- Good interpersonal, customer-service, analytical and decision-making skills, with the ability to effectively prioritize and organize multiple tasks.
- Professional, pleasant phone manner.
- Experience working with home care or personal care agencies a plus.
How To Apply
If you wish to apply for this position, please apply online by clicking the "Apply Now" button or forward your resume, noting the above Job ID #, to:
MetroPlus Health Plan Human Resources Department 160 Water Street 8th Floor New York, NY 10038 Attn: Recruitment Unit
Job Title: Care Management Associate
Location: Metroplus Health Plan
Job ID: 30857
Department: UTILIZATION MANAGEMENT
Full/Part Time: Full-Time
Regular Shift: N/A
Hire In Rate: $35,000.00 (for employees new to HHC)
Salary Range: $40,126.00
Pay Frequency: Year
Source of Funding: General Care
Civil Service Classification: Non Competitive
Post Date: 2016/10/17 - Open Until Filled