Nursing Home Liaison

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 network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlusHealth has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.

Position Overview

Under the guidance of the Managed Long-Term Care (MLTC) Manager of Care Managers, the Nursing Home Liaison provides outreach and support to the MetroPlusHealth MLTC Nursing Home (NH) Team. The Nursing Home Liaison is responsible for working with the NH Team on supporting members to achieve and maintain long-term care placement in residential facilities to ensure this is still the most appropriate setting and that all services and supports are properly delivered in that setting. They also support, as appropriate, the transitioning of MetroPlusHealth members from nursing homes to the community and from nursing home into acute care facilities, outreaching to members post-discharge, coordinating appointments for members who need assistance, working with the care managers on member stratification and referrals to care management.

• Coordinates with the NYS Nursing Home Eligibility Department (NHED) unit for inquiries on N code assignment.
• Coordinates with nursing home facilities to retrieve relevant admission documentation and verifies facilities have submitted required documentation to NYS NHED.
• Uploads all documentation received from NH facilities into appropriate systems.
• Verifies N code assignment in ePACES.
• Interacts with and obtains relevant clinical information from the member's PCP and all other
• applicable providers, vendors, or agencies.
• Coordinates outreach calls to members and providers to facilitate and manage care more effectively.
• Identifies members that are institutionalized that can be transitioned to the community and then adequately coordinating community services and resources.
• Maintains a contact list of services in the community as a referral guide to ensure members obtain access to support systems/community programs to enhance education on disease states and conditions.
• Maintains comprehensive case notes on all members in the medical management systems, as well as other applicable files and databases.
• Assists all MetroPlusHealth departments with the resolution of the member's issues related to LTSS authorizations and services.
• Performs all other duties as required, requested, or assigned.

• Requires a bachelor's degree
• A minimum of five years of experience in care management, utilization management, case/disease management
• A minimum of five years of experience in managed care preferred excellent oral and written communication and analytical skills
• Knowledge of computer systems, especially medical management software

Professional Competencies

• Integrity and Trust
• Customer Service Focus
• Functional/Technical skills
• Written/Oral Communications skills