Care Manager

@ MetroPlusHealth

About MetroPlusHealth

Empower. Unite. Care. MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. As a subsidiary of NYC Health + Hospitals, it serves the five boroughs including Bronx, Brooklyn, Manhattan, Queens and Staten Island.

Position Overview

The Care Manager, under the direction of the Vice President of Clinical Services, manages both simple and complex medical cases to achieve high-quality patient care outcomes and minimize unnecessary medical expenses. The role involves coordinating outpatient and inpatient services, assisting providers in directing care to the appropriate setting, and assessing outcomes through member outreach.

Duties & Responsibilities

• Perform care management including hospital admission certification, continued stay review and discharge planning.
• Oversee coordination and delivery of comprehensive healthcare in a cost-effective manner.
• Interact with providers to obtain clinical information and approve appropriate care.
• Identify utilization trends and potential member needs through data reviews.
• Evaluate member needs and assist with resolution of utilization management issues.
• Conduct medical record reviews and participate in Medical Management grand rounds.

Minimum Qualifications

A High School Diploma or GED with 2-5 years’ clinical experience in an acute or applicable care setting plus UM/UR experience. A New York State license as a Registered Nurse, License Practical Nurse, or Physical Therapist is required.

Benefits & Professional Competencies

• Integrity and Trust
• Customer Focus
• Excellent communication, written and analytical skills
• Knowledge of computer systems

Key skills/competency

• Care Management
• Utilization Management
• Clinical Experience
• Case Management
• Healthcare Coordination
• Communication
• Analytical Skills
• Regulatory Compliance
• Data Analysis
• Team Collaboration