Top 133 Hedis Jobs in New York State

HARP Care Manager 100% Field Based, Licensed Social Workers
MetroPlusHealth —New York, NY
- $85,000 - $97,448 a year
- Acute care
- Bilingual
- LMFT
Quick Apply
Behavioral Health Clinical Quality Improvement Specialist, LCSW (Onsite 3 Days/Week)
VNS Health —New York, NY
- $85,000 - $106,300 a year
- LMFT
- RN License
- Licensed Clinical Social Worker
- Continuing education credits
- Paid holidays
QI & Risk Manager - Healthcare
Bedford Stuyvesant Family Health Center —Brooklyn, NY
- $25 an hour
- Bachelor's degree
- Computer skills
- 1 year
- Paid holidays
- Disability insurance
Quick Apply
Medical Records Reviewer
VNS Health —Manhattan, NY
- $28.09 - $35.08 an hour
- Full-time
- Nursing
- Microsoft Excel
- HIPAA
- Continuing education credits
- Paid holidays
Lead Quality Data Analyst - Remote
EmblemHealth —New York, NY
- $77,760 - $149,040 a year
- Remote
- 5 years
- Finance
- Master's degree
Clinical Quality Manager
Healthfirst —New York, NY
- $83,100 - $120,360 a year
- Full-time
- Hybrid work
- Mid-level
- Health insurance
- Dental insurance
4d
Senior Quality Data Analyst - Remote
EmblemHealth —New York, NY
- $68,040 - $118,800 a year
- Remote
- Mid-level
- Finance
- Master's degree
Medical Management Data Analyst
MetroPlus Health Plan —New York, NY
- $89,000 - $91,000 a year
- Full-time
- Hybrid work
- Mid-level
- Office
- 3 years
Quality Measurement & Improvement Analyst-Senior
Independent Health —Buffalo, NY
- $85,000 - $95,000 a year
- Full-time
- Master's degree
- SQL
- Bachelor's degree
- Paid time off
13d
Manager of Behavioral Health Quality
MetroPlus Health Plan —New York, NY
- $109,955 - $119,955 a year
- Full-time
- Hybrid work
- Microsoft Word
- Microsoft Excel
- RN License
Clinical Analyst (Licensed RN or Licensed SW Req'd)
ISLAND PEER REVIEW ORGANIZATION INC —Jericho, NY
- $75,000 - $95,000 a year
- Full-time
- Nursing
- RN License
- Licensed Clinical Social Worker
Quick Apply
Vice President, Quality Improvement & Utilization Management
Nascentia Health —Latham, NY
- $157,427 - $203,581 a year
- Full-time
- Hybrid work
- Background check
- Pass drug screening
- Analysis skills
- Health savings account
- Paid holidays
RN Care Manager, Population Health Programs
Duet —New York, NY
- $85,000 - $110,000 a year
- Full-time
- Hybrid work
- RN License
- Mid-level
- 3 years
HARP Care Manager 100% Field Based, (LMSW, LCSW, LMHC, LMFT )
MetroPlus Health Plan —New York, NY
- $85,000 - $97,448 a year
- Full-time
- Acute care
- Bilingual
- LMFT
Associate Executive Director Of Strategy and Quality & Safety
NYC Health + Hospitals —New York, NY
- $144,550 - $200,000 a year
- Online Application
- Nursing
- RN License
- 5 years
- Commuter assistance
- Paid holidays
Quality Navigator (Registered Nurse)
AdvantageCare Physicians —Brooklyn, NY
- $81,000 - $96,900 a year
- Nursing
- RN License
- Mid-level
13d
Case Manager, RN or Licensed Behavioral Health (Multiple Openings Available!)
Excellus BlueCross BlueShield —Rochester, NY
- $62,400 - $117,622 a year
- Full-time
- RN License
- Physical & Rehabilitation Medicine
- Licensed Clinical Social Worker
- Health savings account
- Health insurance
Quick Apply
5d
Nurse Practitioner or Physician Assistant - Virtual Health Assessment Team
Oscar Health —New York, NY
- $130,000 - $140,000 a year
- 8 hour shift
- Remote
- Nursing
- RN License
- Internal Medicine
- Paid parental leave
- Paid holidays
Quick Apply
Member Experience Data Analyst, Hybrid
VNS Health —Manhattan, NY
- $77,200 - $96,500 a year
- Full-time
- Hybrid work
- Office
- Master's degree
- SQL
- Continuing education credits
- Paid holidays
Director of Quality and Provider Engagement
CAIPA MSO LLC —New York State
- $120,000 - $150,000 a year
- Hybrid work
- Master's degree
- Analysis skills
- Presentation skills
- Paid holidays
- Health insurance
Quick Apply

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HARP Care Manager 100% Field Based, Licensed Social Workers

MetroPlusHealth -
New York, NY

Quick Apply

Job Details

$85,000 - $97,448 a year

Qualifications

Behavioral health hospital experience
Utilization review
Experience working with individuals with chronic illnesses
Master's degree
Mental health facility experience
Utilization management
Resource utilization in healthcare
Microsoft Teams
Disease state management
Video conferences (communication methods)
Experience working with individuals with substance use disorders
Diabetes care
Managing patients as a clinical case manager
Home & community care experience
Video conferencing systems operation
Substance abuse services in social work

Full Job Description

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.

POSITION OVERVIEW

The Health and Recovery Plan (HARP) Care Manager develops, facilitates, and communicates a plan of care in partnership with the member, his/her assigned Health Home, primary caregiver, the primary and attending physicians, and various Behavioral Health and/or Substance Use Disorder providers. In partnership with these parties, the HARP Care Manager assesses, plans, facilitates, and advocates for options and services to meet a HARP member’s complex health needs through communication and available resources. In addition, the HARP Care Manager is responsible for scheduling aftercare follow-up for members discharging from an acute behavioral health inpatient setting. This position ensures that members have a scheduled appointment in place, completes follow-up and reminder call to member and follows up with providers to ensure member’s compliance with aftercare. This position requires that all case management activities will be performed in field via community and facilities outreach. This position is 100% field based.

Work Shifts

9:00AM - 5:00PM

Duties & Responsibilities

Clinically assess members for acute behavioral and physical health needs. Generating referrals to providers, community-based resources, and appropriate services and other resources to assist in goal achievement.
Conduct Utilization Review for designated Case Management members for some diversionary levels of care. (CORE/HCBS, ACT).
Expected to meet with members in their homes, shelters, other residential settings, at community agencies, hospital inpatient units and/or day hospital programs.
Conduct initial and ongoing Behavioral Health clinical assessments.
Develop a formal plan of care for all services needed for the HARP member. Notify physicians for any changes in member’s plan of care.
Assists members and providers in accessing post-discharge aftercare related appointments. Works with inpatient facility team to identify appropriate follow-up care for CORE and HARP BH members.
Responsible for outreaching members regarding adhering to 7-day follow up appointment to offer a 30-day appointment as part of HEDIS measures
Responsible for mailing discharge aftercare letters with a list of referrals to members not reached by phone.
Collaborate timely follow up with assigned nurses for clinical updates to plans of care.
Document IDT care coordination notes between both internal MetroPlusHealth staff and external Health Home/CMA workers.
Review and Approve submitted Health Home Plans of Care and ensure that CMA’s are conducting timely annual assessments. Review and approve CORE/HCBS requests; educating CMA workers about PROS and IOP options for members who opt out of receiving CORE/HCBS.
Assist providers with achieving pay for performance goals and examine the feasibility of Value Based Payment with high volume providers for HARP line of business.
Educate providers on medication and treatment compliance while also promoting the use of Long Acting Injectables.
Enlist existing provider network in promoting first episode psychosis treatment.
Educate providers to alternate treatment services being promoted by Health + Hospitals in lieu of Inpatient Detox Attends and prepares for bi-Weekly Interdisciplinary Care Team (ICT) meetings which will feature newly enrolled, frequently admitted, high utilizing at risk HARP members.
Attends and prepares for bi-Weekly Interdisciplinary Care Team (ICT) meetings which will feature newly enrolled, frequently admitted, high utilizing at risk HARP members.
Oversee the coordination and delivery of comprehensive, quality healthcare and services for all members requiring care management in a cost-effective manner.
Evaluate housing needs appropriately and assist with housing application process. Collaborating timely with MetroPlusHealth internal housing team for supportive assistance.
Assist members with the coordination of services from various settings as appropriate. Including facilitating discharge from acute setting and alternate settings.
Provides Care Coordination throughout the continuum of care.
Optimizes both the quality of care and the quality of life for the MetroPlusHealth members. Identifies members appropriate for specialty programs.
Documents in a comprehensive manner to ensure that all goals, interventions, and care coordination activities for each member in DCMS (EMR) system, and other applicable software programs, are complaint with professional standards and regulatory guidelines.
Contributes to MetroPlusHealth corporate goals through ongoing execution of member care plans and member goal achievement.
Performs other appropriate HARP Behavioral Health duties and participates in other special projects as assigned, including, but not limited to, audit review and preparation, quality improvement, community health education, facility/provider relations and marketing activities.

Minimum Qualifications

Master’s Degree required
Overall, 3-5 years of Behavioral Health (Serious Mental Illness & Substance Use Disorder) experience in a managed care and or in a Psychiatric Hospital Inpatient and/or Outpatient experience with both case and utilization management.
One-year HARP experience preferred.
Field based Case Management Experience within the Integrated Collaborative Care Model Approach
Experience with chronic condition management, particularly Diabetes, HIV, Heart Disease, Pharmacy, Psyckes, E-Paces, HCS (UAS) MAPP, CORE/HCBS, Microsoft Teams Video knowledge
Strong interpersonal and assessment skills, the ability to remain calm and poised with challenging members who often present as in a constant state of crisis.
Previous history of conducting home visits to members as well as assessing them bedside during an inpatient hospitalization or at their long-term Substance Abuse Residential setting.
Medical Background & Bilingual preferred.
Previous Quality Management liaison experience with hospitals and other large volume providers to address cost. as well as HEDIS/QARR quality performance, preferred.

Licensure and/or Certification Required:

A valid license and current registration to practice as a Licensed Mental Health Counselor (LMHC), Licensed Marriage and Family Therapist (LMFT), Licensed Master Social Worker (LMSW), or Licensed Clinical Social Worker (LCSW) issued by the New York State Education Department (NYSED) is required.

Professional Competencies

Integrity and Trust
Teamwork and Problem-Solving Attitude
Customer Service Member FIRST Focus
Superior Technical Computer skills (Microsoft Office, DCMS, Teams Video Application)
Clear and Concise Written/Oral Communications
Exceptional Organizational and Communication Skills.

#LI-Field #MPH50

Quick Apply

Refine Your Search

hedis jobs in new york state

HARP Care Manager 100% Field Based, Licensed Social Workers

Behavioral Health Clinical Quality Improvement Specialist, LCSW (Onsite 3 Days/Week)

QI & Risk Manager - Healthcare

Medical Records Reviewer

Lead Quality Data Analyst - Remote

Clinical Quality Manager

Senior Quality Data Analyst - Remote

Medical Management Data Analyst

Quality Measurement & Improvement Analyst-Senior

Manager of Behavioral Health Quality

Clinical Analyst (Licensed RN or Licensed SW Req'd)

Vice President, Quality Improvement & Utilization Management

RN Care Manager, Population Health Programs

HARP Care Manager 100% Field Based, (LMSW, LCSW, LMHC, LMFT )

Associate Executive Director Of Strategy and Quality & Safety

Quality Navigator (Registered Nurse)

Case Manager, RN or Licensed Behavioral Health (Multiple Openings Available!)

Nurse Practitioner or Physician Assistant - Virtual Health Assessment Team

Member Experience Data Analyst, Hybrid

Director of Quality and Provider Engagement

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