Claims

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Compliance / Regulatory Affairs

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Customer Services Call Center

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Behavioral Health

Title:Behavioral Health Care Coordinator (Temporary)
Dept:  Behavioral Health
Location:  Adams Street
Job Summary:
The purpose of this position is to ensure that Health Plus members obtain timely, cost-effective, quality behavioral health care in the appropriate setting.  Responsibilities include, but are not limited to inpatient and outpatient admission review and pre-certification, coordination of continuing stay and discharge planning, coordination of behavioral health with other medical services, identification and referral of members for case management and disease management programs, and provision of case management and disease management services as assigned. In all areas the Behavioral Health Care Coordinator is charged with managing the delivery of care in an effective, professional and compassionate manner.

Principle Duties and Responsibilities: 
A.   Inpatient Admission, Authorization, and Concurrent Review
• Identifies, on a daily basis, all members who are currently hospitalized   
• Prioritizes hospitalized patients according to the relevant policies and procedures  
• Conducts initial inpatient review and authorization within established times frames for emergent and non-emergent admissions and determines the appropriateness of admission, anticipated length of stay, treatment plan, and potential discharge needs 
• Documents the inpatient review in the computer system including: diagnoses, procedures, attending physician, treatment plan, anticipated length of stay and needs utilizing American Psychiatric Association, American Academy of Child and Adolescent Psychiatry, and other criteria, utilization management guidelines, and practice guidelines as established by Health Plus 
• Performs concurrent review within established time frames and enters information in the computer system in a timely manner 
• Promptly refers all cases not meeting approved medical necessity criteria, or cases where there is a question on quality of care, to the Behavioral Health Medical Director for review 
• Participates in discharge planning process to ensure timely discharge, appropriate follow up and continuity of care 
• Maintains a timely record of all activity in the computer system 

B.  Outpatient Admission, Authorization, and Concurrent Review 
• Reviews and evaluates all requests for outpatient services according to medical necessity criteria, utilization management guidelines, and practice guidelines established by Health Plus 
• Prior authorizes those services that meet approved medical necessity criteria. Enters authorizations in the computer system 
• Promptly refers any case that does not meet approved medical necessity criteria for prior authorization or cases where there is a question on quality of care to the Behavioral Health Medical Director for review 
• Facilitates appointments for members who have difficulty obtaining appointments, assists the PCP with behavioral health referrals.  Assists the member
• in accessing services, providing patient teaching and support to facilitate
• compliance with the treatment plan. 
• Performs concurrent reviews at established intervals and enters information in the computer system in a timely manner 
• Maintains a timely record of all activity in the computer system 

C.  Utilization Management/Quality Assurance
• Tracks Emergency Department Utilization and intervenes whenever inappropriate use/over-utilization is identified 
• Tracks utilization of the 24 hour behavioral health call center service by reviewing the daily call reports and ensures that response is timely and follow up needs are met 
• Reviews New Enrollee Health History Forms, prioritizes needs and conducts follow up phone interviews where necessary to ensure access to and continuity of care 
• Identifies potential Quality Assurance/Risk Management issues and promptly refers cases to the Director of Behavioral Health/ Behavioral Health Medical Director/Health Plus Medical Director according to the established policies and procedures 
• Prepares Case Summaries and actively participates in Case Conferences 
• Oversees activities of the BHS Representatives and provides performance feedback to the Director of Behavioral Health 
• Accepts and performs additional duties as assigned within the scope of knowledge and skills and in support of the goal of timely and efficient delivery of care 
• Case and Disease Management identifies and refers members for case and disease management according to criteria and protocols established by Health Plus
• Prioritizes levels of case & disease management required based on established protocols
• Manages behavioral health care and coordinates with other health services across the system of care through establishing and maintaining contact with the member, family/guardian as appropriate, behavioral health provider (s), primary care physician, and other involved professionals/agencies as necessary, according to established priority level and procedures for all assigned Case Management cases.
• Conducts disease management activities as assigned by the Director of Behavioral Health, including but not limited to reviewing available data and reports to identify suitable candidates, developing educational materials, and conducting member health education on selected topics. 
Required Skills: 
• Demonstrate the ability to communicate effectively in English.  Prefer ability to communicate effectively in a second language. 
• Demonstrates self-motivation and possesses the ability to solve problems independently 
• Demonstrates commitment to patient advocacy 
• Demonstrates the ability to work with other professionals and paraprofessional staff in a collaborative manner.  Must be a team player 
• Possesses strong organizational skills and is able to handle multiple tasks simultaneously 
• Displays a commitment to quality both in practice and documentation and is able to follow through on all projects in a timely manner 
• Possesses basic computer knowledge and shows a willingness to learn more advanced skills
• Possesses a working knowledge of the NYC metro area behavioral health delivery system 

Required education and Experience:
• Current licensure as a Certified Social Worker or Psychologist in New York State is required
• A minimum of 5 (five) years behavioral health care experience, at least some of which was obtained in a community setting is required
• Recent experience in managed care utilization practices is required
• Certification in Quality Management, Utilization Management or Quality Assurance is preferred
• Experience in community outreach, health education, and/or Discharge Planning is helpful  

Enrollment

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Executive Office

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Finance

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Health Education & Community Outreach

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Health Services

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Human Resources / Training

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ITS

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Marketing / Medicaid

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Marketing / Business Development

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Marketing / Communications

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Marketing / Community Relations

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Marketing / Recertification

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Marketing / Retention / Recertification

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Marketing / Special Events

Title:Community Outreach Vehicle (COV) Operator (Temporary)
Dept: Special Events
Shift: Variable Days, Flexible hours and some OT and possible weekend and holidays
Language: English, Mandarin and Cantonese
Location: 37th St

Job Summary:
Under the direct supervision of Special Events Manager and Supervisor, the COV Operator is responsible for the general maintenance and upkeep of the assigned vehicle, obtaining assigned schedule of events and ensuring the safe delivery of the vehicle to each assigned location.  The COV Operator works closely with the Special Events coordinator and Marketing Representatives by assisting with each assigned marketing event.

Principal Duties and Responsibilities:  *Essential Functions
• Understands and obeys all city traffic ordinances and laws.
• Obtains weekly schedule and maintain a detailed log with information regarding vehicle maintenance and event outcome.
• Inspects vehicle on a daily basis, ensure that vehicles are made safe during their assigned schedule, and submit a detailed report when they become involved in a traffic accident.
• Regularly maintains assigned vehicles, which will include mechanical, cleanliness, supplies, inventory, and update vehicle with latest marketing materials.
• Assists the marketing staff in the distribution of literature at sites and special events; assist with general marketing activity as required.
• Follows interdepartmental dress code guidelines and adhere to all company policies and procedures.
• Manages their cash allotment for supplies and submit receipts.
• Manages their time, plans for alternate routes, and consider weather conditions when driving to a site/event.
• Follows instructions as prescribed.
• Performs other duties as assigned.

Job Specification:
• Must be able to carry out assignments independently.
• Ability to handle fast pace, team oriented environment.
• Must be physically able to handle heavy lifting (packages, equipment and all event related supplies).
• Flexible work schedule, including weekends and holidays.
• Acts to solve problems and uses available resources to come up with alternative solutions.
• Bilingual preferred.

Required Education and Experience:
• Minimum one to two years experience in marketing, special events or related experience.
• Experience in health care setting preferred.
• High School diploma or equivalent.
• Clean, valid New York State Driver’s License required.

Medical Director’s Office

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Medical Management Call Center

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Medicare Marketing/Sales

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Medicare Products

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Member Operations

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Member Services

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Operations

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Provider Relations

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Quality Improvement

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