MetroPlus Health Plan 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’ network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlus has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.
Under the guidance of the MLTC Team Lead, the Care Coordination Specialist provides oversight and direction to members in accordance with the MetroPlus Medical Management policies and procedures. The Care Coordination Specialist is responsible for the transitioning of members from the Nursing Home that are enrolled in MetroPlus Health Plans to the Community, outreach to members post discharge, coordinating appointments for members who need assistance, working with the Care Managers on member stratification and referrals to care management, and providing educational materials on Money Follows the Person Program (MFP), Nursing Home Transition Waiver (NHTD).
Oversees the coordination and delivery of comprehensive, quality healthcare and services for various conditions and diagnoses for MetroPlus members especially those requiring outpatient care/case management, in a cost-effective manner and in concert with the member, PCP and applicable resources.
Provides direct telephonic health education and information to members who require post discharge follow-up care. Follows-up with written materials and coordinates referrals to outpatient programs when needed.
Coordinates with integrated Case Management (ICM) on appropriate treatments plans for members in need of disease/case management.
Interacts with and obtains relevant clinical information from the member’s PCP and all other applicable providers, vendors or agencies.
Coordinates out-reach calls to members and providers to facilitate and manage care more effectively.
Maintains a contact list of services in the community as a referral guide to ensure members obtain access to support systems/community programs to enhance education on disease states and conditions.
Identifies members that are institutionalized that can be transitioned to the community and then adequately coordinating community services and resources.
Maintains comprehensive case notes on all members in the medical management systems, as well as other applicable files and databases.
Assists all MetroPlus departments with the resolution of the member’s issues related to UM activities.
Performs all other duties as required, requested or assigned.
Requires a background in health education, Psychology, Sociology, a LPN or RN, Social Worker or MPH (master’s in public health).
A minimum of two year’s of experience in Care Management and /or Utilization Management, Case/Disease Management.
A minimum of two years’ experience in managed care- preferred.
Excellent communication, written and analytical skills.
Knowledge of computer systems, especially medical management software.
Integrity and Trust
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
This is position is classified as a managerial title, in addition to a variety options for Health Benefits through MetroPlus, managerial employees receive vision, dental, gym reimbursement and life insurance benefits through the Management Benefits fund of the City of New York. Please view the benefits page for more detailed information.