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Healthfirst Field Case Manager - UM - Behavioral Health in New York, New York

The Case Manager - Field, Utilization Management coordinates the care plan for assigned members and conducts pre-certification, concurrent review, discharge planning, and case management as assigned. This position has face-to-face member contact depending on the hospital's limitations and stipulations and therefore, travel to hospitals/free standing facilities is required. This position is expected to collaborate with hospital clinicians and a Care Management team (which may include RN’s, Social Workers, and Coordinators) to evaluate and treat members and provides education and consultation to members, family/caregivers, and other people responsible for the member’s shared care. The Case Manager – Field is also responsible for efficient utilization of health services and optimal health outcomes for members, as well as meeting designated quality metrics.

Provides case management services for assigned member caseloads including:

  • Providing overall case management services for assigned member caseloads

  • Pre-certification – performing risk-identification, preadmission, concurrent, and retrospective reviews to evaluate the appropriateness and medical necessity of treatments and service utilizations based on clinical documentation, regulatory, and MCG criteria and Locadtr

  • Ensuring appropriate access and utilization of a full continuum of network and community resources to support health and recovery

  • Additional duties as assigned.

Minimum Qualifications:

  • RN, LMSW, LMHC, LMFT and/or LCSW license

  • Travel to healthcare facilities as assigned

Preferred Qualifications:

  • Master’s degree in a related discipline

  • Experience in managed care, case management, identifying alternative care options, and discharge planning

  • Certified Case Manager

  • Interqual and/or Milliman knowledge

  • Knowledge of Centers for Medicare & Medicaid Services (CMS) or New York State Department of Health (NYSDOH) regulations governing medical management in managed care

  • Relevant clinical work experience

  • Intermediate Outlook, Basic Word, Excel, PowerPoint, Adobe Acrobat skills.

  • Demonstrated critical thinking and assessment skills to ensure member care plans are followed.

  • Demonstrated ability to manage large caseloads and effectively work in a fast-paced environment

  • Demonstrated professional writing, electronic documentation, and assessment skills.

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.

If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to careers@Healthfirst.org or calling 212-519-1798 . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services.

EEO Law Poster and Supplement (http://www.dol.gov/agencies/ofccp/posters)

All hiring and recruitment at Healthfirst is transacted with a valid “@healthfirst.org” email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst. Healthfirst will never ask you for money during the recruitment or onboarding process.

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