Care Manager - Bilingual Spanish/English

• 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

• NYS LCSW or LMSW (any state)
• For PEDS positions only: 1 year of pediatric clinical field experience and/or experience with families and child serving systems, including child welfare and/or medically fragile/developmentally disabled populations
• For Behavioral Health (BH) Care Management: NYS RN or LCSW, LMSW, LMFT, LMHC, LPC, licensed psychologist (any state)
• 3 years of work experience in a mental/behavioral health or addictions setting
• For BH PEDS positions only: 1 year of pediatric clinical field experience and/or experience with families and child serving systems, including child welfare and/or medically fragile/developmentally disabled populations

• 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
• 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 line
• Relevant work experience preferably as a Care Manager
• Demonstrated ability to manage large caseloads and effectively work in a fast-paced environment
• Proficient with simultaneously navigating the Internet and multi-tasking with multiple electronic documentation systems
• Experience using Microsoft Excel with the ability to edit, search, sort/filter and other Microsoft and PHI systems

medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions