PIC Clinical Care Manager Position Available In New York, New York

PIC Clinical Care Manager MetroPlus Health Plan United States, York, York Jun 10, 2025

PIC Clinical Care Manager Job Ref:

122583

Category:

Utilization Review and Case Management Department:

PARTNERSHIP IN CARE

Location:

50 Water Street, 7th Floor, York,
NY 10004

Job Type:

Regular Employment Type:

Full-Time Hire In Rate:

$85,490.00

Salary Range:

$85,490.00 – $85,490.00 Empower. Unite. Care. MetroPlusHealth is committed to empowering 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 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, 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 Yorkers to live their healthiest life. Position Overview Under the direction of the Director of Care Management (PIC), the PIC Clinical Care Manager (SW) ensures the promotion of health and wellness of HIV-positive, homeless, and transgender members through the development and oversight of an evidence-informed, individualized Plan of Care that addresses their complex
medical, behavioral health and social service needs. This position may be deployed, based on business needs, to health care facilities throughout York City to provide case management services. Job Description
Provides telephonic and/or face-to-face care management services to members at designated HIV primary care facilities, including care coordination, transition of care, out-patient followup, and ancillary service review to ensure optimal health outcomes.
Develops and implements an individualized member Plan of Care utilizing various resources, including, but not limited to member, family care giver, primary care provider, and facilitybased or community-based care manager, focused on health coaching and care coordination activities, aligned with member needs and preferences in reaching their health goals.
Promotes access to and oversees the coordination and delivery of comprehensive, quality healthcare services for HIV-positive, transgender, and homeless members.
Provides health education and coaching on HIV disease, HIV primary and secondary risk reduction, and other chronic co-morbid illness, including, but not limited to hepatitis C,
diabetes and hypertension as indicated by the Plan of Care.
Communicates with the member’s primary care provider, community case manager and all other applicable providers, vendors, or agencies to facilitate the health and wellness of the
member in a coordinated and comprehensive manner.
Identifies service utilization trends and potential member needs through review of encounter data, pharmacy/prescription data, completed member health assessment tools.
Ensures that goals, interventions, and care coordination activities for each member are documented in the electronic health record in compliance with professional standards and
regulatory guidelines.
Mentors and supports the work of HIV Services Health & Wellness Advisors (Level 1) on their assigned team and other teams when requested and participates in the competency
development of HIV Services Health & Wellness Advisors (Level 1).
Attends and prepares for periodic departmental case conferences as assigned. Reviews, identifies, and assesses the member Plan of Care and recommends changes to promote the
health and wellness of the member.
Assists other MetroPlusHealth departments with resolution of member concerns related to retention, utilization management, quality management, customer service, and provider
relations.
Attends approved in-service and external education and training as per department directives.
Performs, as assigned, other special projects and activities, including, but not limited to, audit review and preparation, quality improvement, community health education, facility/provider relations and health plan promotion.
Ensures that coordination of care activities for assigned caseload is compliant with Federal, State, and City regulations, and is consistent with the Mission, Vision and Values of the
organization.
Minimum Qualifications
Master’s degree from an accredited college or university in Social Work is required.
A minimum of two years of clinical experience in HIV care or support systems that includes experience in care coordination, health education and case management.
Experience in managed care is preferred.
Bilingual (English/Spanish) is preferred. Fluency in other languages is welcomed. Licensure and/or Certification Required York State license as an LCSW or LMSW Professional Competencies Integrity and Trust
Customer Focus
Functional/Technical Skills
Excellent interpersonal, organizational communication and analytical skills
Computer literacy with proficiency with Microsoft Office products is required #LI-Hybrid #MPH50