BH Care Manager

BH Care Manager

Job Ref: 137030

Category: Utilization Review and Case Management

Department: BEHAVIORAL HEALTH HARP

Location: 50 Water Street, 7th Floor, New York, NY 10004

Job Type: Regular

Employment Type: Full-Time

Salary Range: $83,000.00 - $83,000.00

Empower. Unite. Care.

MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day.

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 40 years, MetroPlusHealth has been committed to building strong relationships with its members and providers.

Position Overview

Empower. Unite. Care.

MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day.

Under the direction of the Director of Community Outreach, Quality and Compliance, the Senior Quality Analyst position supports the data analysis, monitoring, evaluation, and reporting activities of the Partnership in Care (PIC) department. The analyses they conduct support PIC operations in five key areas: regulatory compliance, care management (including the Advanced Care Management program), quality/performance measurement, special projects/grants, and administrative functions. The role will support the strategic goals of the PIC department to ensure that all MetroPlusHealth HIV- positive members are engaged in care, virally suppressed, and receiving appropriate services. The role requires working knowledge of Microsoft SQL Server, Tableau, and MS Excel.

Duties & Responsibilities

• Oversees data analysis, evaluation and reporting of HIV SNP's Advanced Care Management (ACM) program activities, ensuring timeliness, completeness and accuracy.

• Monitors HIV viral load lab data collection to support viral load suppression quality improvement efforts.

• Performs analysis related to SNP audits and compliance activities to ensure adherence with regulatory requirements.

• Analyzes SNP recertification and membership data to monitor trends in SNP enrollments and disenrollments.

• Designs, plans, and implements of analytical business and technology solutions, i.e., Microsoft SQL Server, Tableau, and MS Excel to support PIC operations, coordinating and collaborating with the IT and Analytics departments as needed.

• Analyzes and monitors contractual compliance and business operations to evaluate inefficiencies (e.g., member enrollment, eligibility verification, retention).

• Analyzes monthly claims data alongside other data sources (gaps in care, CRG scores, etc.) to create member profiles and acuity scores.

• Identifies, prioritizes, and helps distributes members for outreach by PIC staff based on risk and acuity.

• Measures and tracks key performance indicators and targets to effectively monitor PIC department activities including ACD line performance, staff productivity and quality outcomes.

• Performs extraction, import, and export of data from diverse data sources including various database applications.

• Packages data from a variety of reports into a monthly and quarterly PIC departmental dashboard.

• Provides training for internal and external staff regarding analyses, reports, or other relevant topics.

• Ensures accuracy and conducts validation of all reports and analyses.

• Performs statistical analyses to support monitoring and evaluation of PIC department.

• Develops and prepares reports, business presentations, and other materials.

• Assists with the identification, collection, input, and assembly of documents as required for external and internal audits.

• Assists with analysis and reporting for special projects as assigned.

• Attends approved in-service and external education and training as per department directives.

Minimum Qualifications

• Bachelor's degree in Computer Science, Information System, Business Administration, Health Administration, or related field is required.

• Minimum of five years of data analysis experience.

• Familiarity with analytics/BI reporting tools such as SQL, Tableau, and Power BI.

• Advanced working knowledge of Microsoft Office applications including Excel.

• Prefer experience in health care industry and knowledge of Managed Care plan operations.

• Knowledge of concerns of persons living with HIV/AIDS is preferred.

Professional Competencies

• Integrity and Trust

• Customer Focus

• Displays strong communication, interpersonal, and organizational skills across all levels coupled with effective problem solving, conceptual thinking, quantitative, and analytical skills.