Case Management Associate

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 Team Lead and Care Manager, the Care Management Associate (CMA) is a member of a team that provides support to our Medicaid members receiving Personal Care Services (PCS). As an integral team member, the CMA will work in conjunction with the Care Manager to ensure the member receives appropriate and necessary services, ensuring members are connected to care, engage with the member and the member’s care team to identify goals and interventions that will improve their health and community resources that will support their well-being to ensure quality outcomes (i.e., reduction in emergency room visits and hospital admissions, improved member satisfaction, closing and reducing Gaps in Care) and cost effectiveness. The CMA will also support the Team Lead with assignments, reports, referrals, and electronic notifications.

• Problem-solve members’ issues in an independent, resourceful manner
• Perform non-clinical activities for members of varying age, clinical scenario, culture, financial means, social support, and motivation
• Troubleshoots member issues related to transportation, appointments, DME, medication, SDoH
• Ensure members have appointments with their providers
• Engage members/caregivers in a collaborative relationship, empowering them to manage their physical, psychosocial, and environmental health to improve and maintain lifelong well being
• Coordinate required services in accordance with member, caregiver, clinical and non–clinical providers, and care managers when involved
• Advocate for members by assisting them to address challenges, and make informed choices regarding the use of social and other community supports
• Promote communication, both internally and externally to enhance effectiveness of clinical and non-clinical services and overall Case Management services
• Assist members in understanding mechanics and management of health care and social support networks
• Maintain accurate and complete documentation of required information in compliance with risk management, regulatory and accreditation requirements
• Assist member in research and understanding of benefit and claims information and resolution
• Protect the confidentiality of member information and adheres to all company policies regarding confidentiality
• Employ critical thinking and judgment when dealing with unplanned issues
• Collect and prepare data, statistics, proposals and reports relevant to responsibilities as a Care Management Associate
• Comply with all orientation requirements, annual and other mandatory trainings, organizational and departmental policies and procedures, and actively participate in evaluation process
• Ensures compliance with Federal, State, and City regulations, and is consistent with the Mission, Vision, and Values of the organization
• Performs other appropriate duties and participates in other special projects as assigned by Leadership

• Associate’s Degree required; Bachelor’s Degree preferred
• A minimum of two years of experience in a healthcare-related field is required. Managed Care, care management/coordination, health education, health home or community-based experience is preferred
• Proficiency with computers navigating in multiple systems and web-based applications including Excel

Professional Competencies

• Integrity and Trust
• Customer Focus
• Functional/Technical skills
• Written/Oral Communications
• Strong customer service skills to coordinate service delivery including attention to members/caregivers, sensitivity to concerns, proactive identification and rapid resolution of issues to promote positive outcomes for members
• Demonstrated ability to communicate effectively, problem solve and work effectively with people
• Excellent time management and organizational skills
• Ability to prioritize and manage changing priorities under pressure

#LI-Hybrid