Description and Requirements The Complex Care Manager plans and manages behavioral and/or physical care and works collaboratively with the members and their health care team across the continuum of care. This role will support a wide variety of areas including chronic disease management, Hospice/Palliative care, Transitions of Care and medically complex members. The Complex Care Manager is responsible for applying care management principles when engaging members and addressing coordination of their health care services by providing an excellent member experience, addressing barriers, addressing care gaps, and improving health outcomes.

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:

NYS RN

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, Korean, Mandarin, or Cantonese.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 lineRelevant work experience preferably as a Care ManagerDemonstrated ability to manage large caseloads and effectively work in a fast-paced environmentProficient with simultaneously navigating the Internet and multi-tasking with multiple electronic documentation systemsExperience using Microsoft Excel with the ability to edit, search, sort/filter and other Microsoft and PHI systems

Hiring Range*:

Greater New York City Area (NY, NJ, CT residents): $81,099 - $116,480

All Other Locations (within approved locations): $71,594 - $106,080

As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.

In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.

*The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role.