Health & Wellness Advisor I (Case Management)

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, 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'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.

Position Overview

Under the direction of the Team Lead and Care Manager, the Health & Wellness Advisor I (HWA I) is a member of a team that provides care management services to our high-risk Medicaid members to ensure the promotion of their health and wellness. As an integral team member, the HWA I will work in conjunction with the Care Manager to ensure the member receives Comprehensive or Transitions of Care Management.

The HWA I will engage with the member and the member’s care team to identify goals and interventions that will improve their health and community resources that will support their well-being to ensure quality outcomes (i.e., reduction in emergency room visits and hospital admissions, improved member satisfaction, closing and reducing Gaps in Care) and cost effectiveness.

Job Description

• Orients high-risk members being care managed to MetroPlusHealth’s suite of services available to them.
• Performs case management activities including care coordination, planning for transition of care, out-patient follow-up, and ancillary service review throughout the continuum of care to ensure optimum health outcomes.
• Troubleshoots member issues related to transportation, appointments, DME, medication, SDoH.
• Ensure members have appointments with their providers.
• Formulates Care Plan with goals & interventions utilizing member preferences, and available clinical data/collateral resources, to identify and address gaps in 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.
• Documents in a comprehensive manner to ensure that all goals, interventions, and care coordination activities for each member in the DCMS system and other applicable software programs are in compliance with professional standards and regulatory guidelines.
• As needed, participates in Interdisciplinary Care Team (ICT) phone meetings to coordinate member’s care.
• Provides care coordination that reduces avoidable utilization, increases member satisfaction and retention, and reduces gaps in care.
• Assists all MetroPlusHealth departments with resolution of related member retention, utilization management, quality management, customer service, and provider relations concerns.
• Attends approved in-service and external education and training as per department directives.
• Performs other appropriate duties and participates in other special projects as assigned, including, but not limited to, audit review and preparation, quality improvement, community health education, facility/provider relations and marketing activities.
• Ensures compliance with Federal, State, and City regulations, and is consistent with the Mission, Vision and Values of the organization.

Minimum Qualifications

• Bachelor's degree from an accredited college or university in a healthcare-related field is required.
• A minimum of two years of care management/coordination, health education, health home or community-based experience required. Managed Care experience is preferred.

Professional Competencies

• Integrity and Trust
• Customer Focus
• Functional/Technical Skills
• Written/Oral Communications

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