NYC Health Hospitals Care Manager in United States

Marketing Statement

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.

Purpose of Position:

The Care Manager under the direction of the Director of the Department of Utilization/Care Management, is primarily responsible for managing both simple and complex medical cases to achieve high-quality patient care outcomes and minimize unnecessary medical expenses, through the coordination of services, both outpatient and inpatient. The Care Manager will assist the provider in directing care to the most appropriate setting, evaluating alternative care plans, and assessing outcomes through outreach to the members.

Key Responsibilities:

  1. Performs care management including hospital admission certification, continued stay review, discharge planning, out-patient and ancillary services review, etc., following established MetroPlus Utilization Management policies, procedures and protocols.
  2. Oversee the coordination and delivery of comprehensive, quality healthcare and services for all members requiring care management in a cost-effective manner.
  3. Interacts and obtains relevant clinical information from member‘s PCP and other providers; approves care that meets established criteria; and refers all other cases to the MetroPlus Physician Advisor/Medical Director. Inform members and providers of Utilization Management determinations and treatment alternatives.
  4. Identifies utilization trends and potential member needs by means of generating reports of encounter data, pharmacy data review, and new member health assessment forms.
  5. Evaluate member needs for referred cases (from providers or member self-referred).
  6. Assists all departments with the resolution of members’ problems related to utilization management issues.
  7. Performs all Utilization Management activities in compliance with all regulatory agency requirements.
  8. Conducts medical record reviews as appropriate to case management functions.
  9. Participate in Medical Management grand rounds with the Physician Advisor.
  10. Performs all other duties as assign.

Minimum Qualifications

  • Registered Nurse, Current New York State license.
  • Bachelor’s Degree (BSN) preferred.
  • A minimum of three to five years clinical experience in an acute care setting.
  • Excellent communication, written and analytical skills.
  • Knowledge of computer systems.

UM/UR experience in managed care or hospital setting preferred

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 Manager

Location: Metroplus Health Plan

Job ID: 30848


Full/Part Time: Full-Time

Regular/Temporary: Regular

Regular Shift: N/A

Hire In Rate: $65,000.00 (for employees new to HHC)

Salary Range: $75,000.00

Pay Frequency: Year

Source of Funding: General Care

Civil Service Classification: Managerial

Post Date: 2016/10/17 - Open Until Filled