BH Care 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 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

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.

• 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 member
• Receives incoming calls from the Behavioral Health (BH) Automatic Call Distribution (ACD) line, conducting warm transfers between members and the clinical behavioral health case manager
• Manages calls to and from providers regarding both inpatient and outpatient BH authorizations, HCBS referrals, specialty (PCP) visits, tests, and faxed care plans
• Liaison between MetroPlusHealth and HHA/PCA vendors re: communication about service to members
• Attach incoming Health Home Plans of Care to members chart and send notification task to appropriate BH queue in DCMS
• Enter 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 member
• Notifies vendors of end of or cancellation of services for member
• Monitors the assigned queues in the authorization system (Care Connect) to ensure timely processing of service authorization requests
• Tracks and monitors key information identified by the Team Lead for quality purposes
• Track and monitor members’ admission to hospitals, nursing home facilities, ER visits and unexpected outcomes
• Track and monitor members’ documentation required for authorization and re-authorization of Personal Care Services. This includes coordinating the completion of Doctor’s orders or M11qs
• Print and mail Home Health Aide/Personal Care Aide Plan of Care
• Track member’s short-term absence from geographic areas
• Notifies Care Manager if a member cannot be contacted
• Documents 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 day
• Complete missing information from documentation received
• Timely communicates member issues or needs and monitors screening of members effectively to improve quality and cost outcomes
• All other tasks assigned by the Team Lead or the Behavioral Health management team

Minimum Qualifications

• High School graduation or evidence of having satisfactory passed a High School Equivalency Program; and
• One year of satisfactory full-time professional work experience
• Demonstrated ability to accurately document calls into a computer system
• Understanding of Medical terminology preferred
• Knowledge of Health Homes and HCBS preferred
• Prior managed care experience preferred
• Prior experience in healthcare customer services and/or case management preferred
• Language Preferences-Spanish, Mandarin, Cantonese, Russian, French, Creole

Professional Competencies

• Integrity and Trust
• Teamwork and Problem Solving
• Customer Service Focus
• Basic Microsoft Word, Teams and Excel skills
• Written/Oral Communications

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