MetroPlusHealth
Behavioral Health Care Management Associate
MetroPlusHealth, New York, New York, us, 10261
Empower. Unite. Care.
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.
About NYC Health + Hospitals
MetroPlus Health
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 Health
network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlus Health
has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.
Position Overview
The BH Care Management Associate (CMA), under the direction of the BH CMA Supervisor, is responsible for the daily activities of the member case intake functions and associated workflow, as well as for performing other duties associated with the coordination of member care as outlined for the Core Behavioral Health and Harp Teams. The BH CMA is responsible for assisting the BH Care Managers with non-clinical activities such as creating cases and events; providing telephonic outreach to members, providers and community based organizations; handling member mailings; faxing clinical requests and individual Care Plans on behalf of the BH team.
Job Description
Handles calls to and from members to assist with benefits questions/issues and help schedule necessary medical appointments as identified by CM staff and/or memberReceives incoming calls from the Behavioral Health (BH) Automatic Call Distribution (ACD) line, conducting warm transfers between members and the clinical behavioral health case managerManages calls to and from providers regarding both inpatient and outpatient BH authorizations, HCBS referrals, specialty (PCP) visits, tests, and faxed care plansLiaison between MetroPlusHealth and HHA/PCA vendors re: communication about service to membersAttach incoming Health Home Plans of Care to members chart and send notification task to appropriate BH queue in DCMSEnter prior approvals in the authorization System (CareConnect).Use CareConnect system to enter authorization or services as per benefit of the program.Notifies vendors of the start date of the services to memberNotifies vendors of end of or cancellation of services for memberMonitors the assigned queues in the authorization system (Care Connect) to ensure timely processing of service authorization requestsTracks and monitors key information identified by the Team Lead for quality purposesTrack and monitor members' admission to hospitals, nursing home facilities, ER visits and unexpected outcomesTrack and monitor members' documentation required for authorization and re-authorization of Personal Care Services. This includes coordinating the completion of Doctor's orders or M11qsPrint and mail Home Health Aide/Personal Care Aide Plan of CareTrack member's short-term absence from geographic areasNotifies Care Manager if a member cannot be contactedDocuments Health Home calls in the absence of assigned primary BH CM; informs TL about such calls and the need for future follow up within one business dayComplete missing information from documentation receivedTimely communicates member issues or needs and monitors screening of members effectively to improve quality and cost outcomesAll other tasks assigned by the Team Lead or the Behavioral Health management teamMinimum Qualifications
Minimum Qualifications
High School graduation or evidence of having satisfactory passed a High School Equivalency Program; andOne year of satisfactory full-time professional work experienceDemonstrated ability to accurately document calls into a computer systemUnderstanding of Medical terminology preferredKnowledge of Health Homes and HCBS preferredPrior managed care experience preferredPrior experience in healthcare customer services and/or case management preferredLanguage Preferences-Spanish, Mandarin, Cantonese, Russian, French, CreoleProfessional Competencies
Integrity and TrustTeamwork and Problem SolvingCustomer Service FocusBasic Microsoft Word, Teams and Excel skillsWritten/Oral Communications
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.
About NYC Health + Hospitals
MetroPlus Health
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 Health
network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlus Health
has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.
Position Overview
The BH Care Management Associate (CMA), under the direction of the BH CMA Supervisor, is responsible for the daily activities of the member case intake functions and associated workflow, as well as for performing other duties associated with the coordination of member care as outlined for the Core Behavioral Health and Harp Teams. The BH CMA is responsible for assisting the BH Care Managers with non-clinical activities such as creating cases and events; providing telephonic outreach to members, providers and community based organizations; handling member mailings; faxing clinical requests and individual Care Plans on behalf of the BH team.
Job Description
Handles calls to and from members to assist with benefits questions/issues and help schedule necessary medical appointments as identified by CM staff and/or memberReceives incoming calls from the Behavioral Health (BH) Automatic Call Distribution (ACD) line, conducting warm transfers between members and the clinical behavioral health case managerManages calls to and from providers regarding both inpatient and outpatient BH authorizations, HCBS referrals, specialty (PCP) visits, tests, and faxed care plansLiaison between MetroPlusHealth and HHA/PCA vendors re: communication about service to membersAttach incoming Health Home Plans of Care to members chart and send notification task to appropriate BH queue in DCMSEnter prior approvals in the authorization System (CareConnect).Use CareConnect system to enter authorization or services as per benefit of the program.Notifies vendors of the start date of the services to memberNotifies vendors of end of or cancellation of services for memberMonitors the assigned queues in the authorization system (Care Connect) to ensure timely processing of service authorization requestsTracks and monitors key information identified by the Team Lead for quality purposesTrack and monitor members' admission to hospitals, nursing home facilities, ER visits and unexpected outcomesTrack and monitor members' documentation required for authorization and re-authorization of Personal Care Services. This includes coordinating the completion of Doctor's orders or M11qsPrint and mail Home Health Aide/Personal Care Aide Plan of CareTrack member's short-term absence from geographic areasNotifies Care Manager if a member cannot be contactedDocuments Health Home calls in the absence of assigned primary BH CM; informs TL about such calls and the need for future follow up within one business dayComplete missing information from documentation receivedTimely communicates member issues or needs and monitors screening of members effectively to improve quality and cost outcomesAll other tasks assigned by the Team Lead or the Behavioral Health management teamMinimum Qualifications
Minimum Qualifications
High School graduation or evidence of having satisfactory passed a High School Equivalency Program; andOne year of satisfactory full-time professional work experienceDemonstrated ability to accurately document calls into a computer systemUnderstanding of Medical terminology preferredKnowledge of Health Homes and HCBS preferredPrior managed care experience preferredPrior experience in healthcare customer services and/or case management preferredLanguage Preferences-Spanish, Mandarin, Cantonese, Russian, French, CreoleProfessional Competencies
Integrity and TrustTeamwork and Problem SolvingCustomer Service FocusBasic Microsoft Word, Teams and Excel skillsWritten/Oral Communications