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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.
Purpose of Position:
Working exclusively at MetroPlus, the MetroPlus Care Coordinator, with varying degrees of latitude for independent initiative and judgment, coordinates and monitors the management of patient-centered quality care, ensuring optimal utilization of resources, service delivery, and compliance with external review requirements and applicable state and federal rules and regulations and nursing standards of care for better outcomes and improved patient experience. Facilitates patient's progress from admission through post-discharge care. There are two (2) Assignment Levels within this class of positions; all personnel perform related work.
Duties & Responsibilities
Assignment Level I
Performs assigned duties related to review and quality assurance of patient documentation, review of the plan of care, and facilitation and implementation of discharge plans. The following are typical tasks for Assignment Level I:
Examples of Typical Tasks:
1. Reviews each patient's chart. Ensures that documentation in the medical record supports the plan of care and justifies admission, pre and post-discharge care. Coordinates and facilitates timely implementation of discharge plans for patient; ensures timely completion of discharge, transfer and referral forms, prescriptions, and discharge orders; arranges follow-up care, as appropriate.
2. Coordinates and/or participates in multidisciplinary rounds; reviews plan of care; and discusses estimated length of stay, need for continued hospitalization and appropriateness of resources utilization, consultations, treatment plan and discharge plan. Completes Patient Review Instrument (PRI).
3. Collaborates and consults with physicians and other health care professionals to reach an efficient pathway of caretaking and to identify, eliminate, and implement solutions to barriers, and collects and analyzes related data, as needed.
4. Communicates with hospital investigation/reimbursement department and third-party payers to obtain authorizations and ensure appropriate reimbursement, and provides clinical reviews and updates to managed care companies, as needed.
5. Plans and implements strategies to reduce length of stay, reduce resource consumption, and achieve positive client/patient outcomes. May coordinate the implementation of community and System initiatives designed to increase revenue. Maintains all related records and documentation.
6. Initiates discharge planning by assessing client/patient and family needs, including but not limited to identifying non-medical psychosocial needs and post discharge medical needs. Informs patient and family of discharge planning options based on diagnosis, prognoses, resources and preferences related to home care services.
7. Performs or coordinates the post Emergency Department discharge phone call to patient and health care providers to facilitate/coordinate and verify that successful linkage to care occurred. Provides telephonic and field assistance to members (visit members' homes, shelters, hospitals, diagnostic centers, etc.
8. Maintains effective communication with physicians, nursing staff, clients/patients, families and others related to discharge planning; coordinates with social services personnel to provide needed services.
9. Contacts and directly engages patient's primary care physician and/or health care providers and institutions to support continuity of care and effective care transition.
10. Works with Community Based Organizations, NYCHA and other agencies to arrange housing, ensure member adherence to care plans, assist in scheduling follow-up appointments and assist in member access to prescription refills.
11. May interview, orient, train, mentor and coach new care management staff, and coordinate and supervise the performance of care coordinators and social work staff performing discharge planning and assessment.
12. May collaborate in the development of departmental policies and procedures, clinical practice guidelines and critical pathways for designated targeted diagnosis.
13. May act as an educational resource and provide consultation regarding case management, discharge planning process, clinical documentation requirements and applicable federal, state and local regulations; may identify benefits, implications, and limitations of home care.
14. Participates in internal/external quality assurance/performance improvement (QA/PI) activities aand programs, facility-wide training, staff meetings, and relevant health care events, as required.
15. Ensures ongoing compliance and maintenance of the NYC Health + Hospitals policies with national standards and other applicable external regulatory requirements and guidelines.
16. Performs other related duties, as directed.
Minimum Qualifications
Qualification Requirements:
1. Valid New York State license and current registration to practice as a Registered Professional Nurse issued by the New York State Education Department (NYSED); and,
2. A Baccalaureate degree from an accredited college or university in Nursing or related health care field; and,
3. Two (2) years of experience as a Registered Professional Nurse.
Benefits
NYC Health and Hospitals offers a competitive benefits package that includes:

• Comprehensive Health Benefits for employees hired to work 20+ hrs. per week
• Retirement Savings and Pension Plans
• Paid Holidays and Vacation in accordance with employees' Collectively bargained contracts
• Loan Forgiveness Programs for eligible employees
• College tuition discounts and professional development opportunities
• College Savings Program
• Union Benefits for eligible titles
• Multiple employee discounts programs
• Commuter Benefits Programs