Care Manager, Bilingual Spanish - 100% Remote

Healthfirst; United States; Remote; USD 60,000 - 80,000; Full time

Job summary

An established industry player is seeking a dedicated Care Manager to oversee behavioral and physical care for members. In this role, you will collaborate with healthcare teams to ensure members receive exceptional care and support. Your responsibilities will include developing care plans, conducting assessments, and advocating for members' needs. This position offers the opportunity to make a significant impact on health outcomes while working in a dynamic environment. If you're passionate about improving lives and have a strong background in care management, this is the perfect opportunity for you.

Qualifications

• Minimum of NYS RN or LCSW/LMSW required for care management.
• 3 years of experience in mental/behavioral health settings preferred.

Responsibilities

• Advocate and educate members on health benefits and self-management.
• Develop care plans and coordinate with multidisciplinary teams.

Skills

Interpersonal Skills

Assessment Skills

Fluency in Spanish

Knowledge of Community Health Practices

Ability to Manage Large Caseloads

Education

NYS RN

LCSW

LMSW

LMFT

LMHC

LPC

Licensed Psychologist

Tools

Microsoft Excel

Electronic Documentation Systems

Job description

The Care Manager plans and manages behavioral and/or physical care with members and works collaboratively with them, their supports, providers, and health care team members. The Care Manager is responsible for applying care management principles when engaging members and addressing coordination of their health care services to provide an excellent member experience, address barriers, and improve their health outcomes. The Care Manager is assigned to a specific product line such as CompleteCare, SNP, Medicaid/Medicare, PHSP, HARP, etc.

Duties and Responsibilities:

• Advocates, informs, and educates beneficiaries on services, self-management techniques, and health benefits.
• Conducts assessments to identify barriers and opportunities for intervention.
• Develops care plans that align with the physician’s treatment plans and recommends interventions that align with proposed goals.
• Generates referrals to providers, community-based resources, and appropriate services and other resources to assist in goal achievement and maintenance of successful health outcomes.
• Liaise between service providers such as doctors, social workers, discharge planners, and community-based service providers to ensure care is coordinated and care needs are adequately addressed.
• Coordinates and facilitates with the multi-disciplinary health care team as necessary to ensure care plan goals and treatment is person-centered and maximizes member health outcomes.
• Assists in identifying opportunities for alternative care options based on member needs and assessments.
• Evaluates service authorizations to ensure alignment and execution of the member’s care and physician treatment plan.
• Contributes to corporate goals through ongoing execution of member care plans and member goal achievement.
• Documents all encounters with providers, members, and vendors in the appropriate system in accordance with internal and established documentation procedures; follows up as needed; and updates care plans based on member needs, as appropriate.
• Occasional overtime as necessary.
• Additional duties as assigned.

Minimum Qualifications:

• For Medical Care Management:
  • NYS RN or
  • LCSW or LMSW (any state)
  • For PEDS positions only: 1 year of pediatric clinical field experience and/or experience with families and child serving systems, including child welfare and/or medically fragile/developmentally disabled populations
• For Behavioral Health (BH) Care Management:
  • NYS RN or
  • LCSW, LMSW, LMFT, LMHC, LPC, licensed psychologist (any state)
    • 3 years of work experience in a mental/behavioral health or addictions setting
  • For BH PEDS positions only: 1 year of pediatric clinical field experience and/or experience with families and child serving systems, including child welfare and/or medically fragile/developmentally disabled populations

Preferred Qualifications:

• Strong interpersonal and assessment skills, especially the ability to relate well with seniors, their families, and community care providers, along with demonstrated ability to handle rapidly changing situations.
• Fluency in Spanish
• Knowledge and experience with the current community health practices for the frail adult population and cognitive impaired seniors.
• Experience managing member information in a shared network environment using paperless database modules and archival systems.
• Experience and knowledge of the relevant product line
• Relevant work experience preferably as a Care Manager
• Demonstrated ability to manage large caseloads and effectively work in a fast-paced environment
• Proficient with simultaneously navigating the Internet and multi-tasking with multiple electronic documentation systems
• Experience using Microsoft Excel with the ability to edit, search, sort/filter and other Microsoft and PHI systems