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Job Ref: 104386

Category: Utilization Review and Case Management

Department: PARTNERSHIP IN CARE

Location: 50 Water Street, 7th Floor,

New York,
NY 10004


Job Type: Regular

Employment Type: Full-Time



Salary Range: $96,682.00 - $96,682.00

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.

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's 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

Under the direction of the Director of Care Management (PIC), the Health & Wellness Advisor Level 2 (RN) ensures the promotion of health and wellness of HIV-positive, homeless, and transgender members through the development and oversight of an evidence-informed, individualized Plan of Care that addresses their complex medical, behavioral health and social service needs. This position may be deployed, based on business needs, to health care facilities throughout New York City to provide care management services.

• Provides telephonic and/or face-to-face care management services to members at designated HIV primary care facilities, including care coordination, transition of care, out-patient follow-up and ancillary service review to ensure optimal health outcomes.
• Develops and implements an individualized member Plan of Care utilizing various resources, including, but not limited to member, family care giver, primary care provider, and facility-based or community-based care manager, focused on health coaching and care coordination activities, aligned with member needs and preferences in reaching their health goals.
• Promotes access to and oversees the coordination and delivery of comprehensive, quality healthcare services for HIV-positive, transgender, and homeless members.
• Provides health education and coaching on HIV disease, HIV primary and secondary risk reduction, and other chronic co-morbid illness, including, but not limited to hepatitis C, diabetes and hypertension as indicated by the Plan of Care.
• Communicates with the member's primary care provider, community care manager and all other applicable providers, vendors, or agencies to facilitate the health and wellness of the member in a coordinated and comprehensive manner.
• Identifies service utilization trends and potential member needs by means of reviewing encounter data, pharmacy/prescription data, and the review of member health assessment tools.
• Ensures that goals, interventions, and care coordination activities for each member are documented in the electronic health record and in compliance with professional standards and regulatory guidelines.
• Mentors and supports the work of Health & Wellness Advisors (Level 1) on their assigned team and other teams when requested and participates in the competency development of & Wellness Advisors (Level 1).
• Attends and prepares for periodic departmental case conferences as assigned. Reviews, identifies, and assesses the member Plan of Care and recommends changes to promote the health and wellness of the member.
• Assists other MetroPlusHealth departments with resolution of member concerns related to retention, utilization management, quality management, customer service, and provider relations.
• Attends approved in-service and external education and training as per department directives.
• Implements clinically focused member assessment and health coaching - activities to address HEDIS quality measures.
• Conducts member transitions of care medication reconciliation to improve clinical outcomes.
• Performs, as assigned, other special projects and activities, including, but not limited to, audit review and preparation, quality improvement, community health education, facility/provider relations and health plan promotion.
• Ensures that coordination of care activities for assigned caseload is compliant with Federal, State, and City regulations, and is consistent with the Mission, Vision and Values of the organization.

• Bachelor's degree from an accredited college or university in a healthcare-related field is required. Master's degree from an accredited college or university in Nursing, Social Work or other healthcare related discipline is preferred.
• A minimum of two years of clinical experience in HIV care or support systems that includes experience in care coordination, health education and care management. A minimum of two years of experience in managed care is preferred.
• Computer literacy with proficiency with Microsoft Office products is required.
• Bilingual (English/Spanish) is preferred. Fluency in other languages is welcomed.
• New York State license as a registered professional nurse

Professional Competencies

• Integrity and Trust
• Customer Focus
• Functional/Technical Skills
• Excellent interpersonal, organizational communication and analytical skills.

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