The Care Manager plans and manages behavioral and/or physical care with members and works collaboratively with them, their supports, providers, and health care team members. The Care Manager is responsible for applying care management principles when engaging members and addressing coordination of their health care services to provide an excellent member experience, address barriers, and improve their health outcomes. The Care Manager is assigned to a specific product line such as CompleteCare, SNP, Medicaid/Medicare, PHSP, HARP, etc.
Duties and Responsibilities
- Dual Eligibility Plan Management: Responsible for overseeing dual eligibility plans.
- Member Advocacy: Advocates, informs, and educates beneficiaries on services, self-management techniques, and health benefits.
- Assessments: Conducts assessments to identify barriers and opportunities for intervention.
- Care Plan Development: Develops care plans that align with the physician's treatment plans and recommends interventions that align with proposed goals.
- Referrals: Generates referrals to providers, community-based resources, and appropriate services to assist in goal achievement and maintenance of successful health outcomes.
- Liaison Role: Acts as a liaison between service providers such as doctors, social workers, discharge planners, and community-based service providers to ensure coordinated care.
- Coordination with Health Care Team: Coordinates and facilitates with the multi-disciplinary health care team to ensure care plan goals and treatments are person-centered and maximize member health outcomes.
- Alternative Care Options: Assists in identifying opportunities for alternative care options based on member needs and assessments.
- Service Authorization Evaluation: Evaluates service authorizations to ensure alignment and execution of the member's care and physician treatment plan.
- Corporate Goal Contribution: Contributes to corporate goals through ongoing execution of member care plans and member goal achievement.
- Documentation: Documents all encounters with providers, members, and vendors in the appropriate system according to internal and established documentation procedures; follows up as needed and updates care plans based on member needs.
- Occasional Overtime: May require occasional overtime.
- Additional Duties: Performs additional duties as assigned.
Minimum Qualifications
Medical Care Management
- NYS RN or
- LCSW or LMSW (any state)
For PEDS Positions
- 1 year of pediatric clinical field experience and/or experience with families and child-serving systems, including child welfare and/or medically fragile/developmentally disabled populations.
Behavioral Health (BH) Care Management
- NYS RN or
- LCSW, LMSW, LMFT, LMHC, LPC, licensed psychologist (any state)
- 3 years of work experience in a mental/behavioral health or addictions setting
For BH PEDS Positions
- 1 year of pediatric clinical field experience and/or experience with families and child-serving systems, including child welfare and/or medically fragile/developmentally disabled populations.
For CASAC Positions
- Credentialed Alcohol and Substance Abuse Counselor
Preferred Qualifications
- Strong interpersonal and assessment skills, especially the ability to relate well with seniors, their families, and community care providers.
- Fluency in Spanish, Korean, Mandarin, or Cantonese.
- Knowledge and experience with current community health practices for the frail adult population and cognitively impaired seniors.
- Experience managing member information in a shared network environment using paperless database modules and archival systems.
- Relevant work experience preferably as a Care Manager.
- Demonstrated ability to manage large caseloads and effectively work in a fast-paced environment.
- Proficient with simultaneously navigating the Internet and multi-tasking with multiple electronic documentation systems.
- Experience using Microsoft Excel with the ability to edit, search, sort/filter, and other Microsoft and PHI systems.
Hiring Range
- Greater New York City Area (NY, NJ, CT residents): $81,099 - $116,480
- All Other Locations (within approved locations): $71,594 - $106,080
As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.
In addition to your salary, Healthfirst offers employees a full range of benefits such as medical, dental, and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.
The hiring range is defined as the lowest and highest salaries that Healthfirst in "good faith" would pay to a new hire, or for a job promotion, or transfer into this role.
Equal Opportunity Employer
We are an Equal Opportunity Employer. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province, or Local status unrelated to the performance of the work involved.
Perks and Benefits
Health and Wellness
- Health Insurance
- Health Reimbursement Account
- Dental Insurance
- Vision Insurance
- Life Insurance
- Short-Term Disability
- Long-Term Disability
- FSA
- HSA
- Fitness Subsidies
- Mental Health Benefits
- Pet Insurance
Parental Benefits
- Birth Parent or Maternity Leave
- Family Support Resources
Work Flexibility
- Remote Work Opportunities
- Hybrid Work Opportunities
Office Life and Perks
- Commuter Benefits Program
- Casual Dress
- Happy Hours
- Company Outings
- Holiday Events
Vacation and Time Off
- Paid Vacation
- Paid Holidays
- Personal/Sick Days
- Volunteer Time Off
Financial and Retirement
- 401(K) with Company Matching
- Performance Bonus
Professional Development
- Internship Program
- Tuition Reimbursement
- Promote From Within
- Access to Online Courses
- Lunch and Learns
- Associate or Rotational Training Program
- Learning and Development Stipend
Diversity and Inclusion
- Employee Resource Groups (ERG)
- Woman Founded/Led
- Diversity, Equity, and Inclusion Program
How to Apply
Interested candidates should click on the link to apply for the job
Conclusion
The role of a Care Manager is vital in ensuring that members receive comprehensive, coordinated care tailored to their unique health needs. By effectively managing behavioral and physical care, developing and implementing individualized care plans, and working collaboratively with a multidisciplinary team, Care Managers play a crucial part in improving health outcomes and enhancing the overall member experience.
Healthfirst offers a dynamic work environment where Care Managers are supported with extensive resources, competitive compensation, and a commitment to professional development
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