MetroPlus Health Plan
Medicaid Care Manager Team Lead Registered Nurse
MetroPlus Health Plan, New York, New York, us, 10261
Medicaid Care Manager Team Lead Registered Nurse
Job Ref:
129643
Category:
Utilization Review and Case Management
Department:
CASE MANAGEMENT
Location:
50 Water Street, 7th Floor, New York, NY 10004
Job Type:
Regular
Employment Type:
Full-Time
Salary Range:
$123,588.00 - $123,588.00
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 Under the direction of the Director of Medicaid, the Medicaid Care Manager Team Lead ensures that staff adhere to the Medicaid contractual requirements, policies and procedures, and workflows established to manage the vulnerable Medicaid population.
The Medicaid Care Manager Team Lead manages the daily activities of the Medicaid team (Care Managers and Care Management Associates) to ensure quality outcomes in the delivery of member-centered case management including reduction in emergency room visits and hospital admissions, improved member satisfaction, improved member health, and cost effectiveness.
Work Shifts 9:00 A.M - 5:00 P.M
Duties & Responsibilities
Provide clinical guidance and supervision to assigned Care Managers and clinical support staff to promote efficient and effective delivery of care management services
Supervise day to day activities to make certain that case management services are provided in accordance with clinical guidelines, established processes and MetroPlusHealth organizational standards
Supervise the entire care management workflow including case referrals, assignments, interventions and goal setting, follow‑up/follow‑through activities, documentation, and escalations
Ensure care management activities are conducted in a safe, efficient, and effective manner to promote continuity and quality of care
Review, develop and modify day to day workflows to ensure timely follow‑up
Perform ongoing quality review of cases to ensure accuracy and compliance
Evaluate.includes staff performance; coach staff to improve both quality and quantity of skills attaining optimal performances
Utilize data to track, trend and report productivity and outcome measures, work with the management team to implement necessary improvement strategies
Coordinate Interdisciplinary Care Team rounds with providers, care managers and care management associates, this include scheduling meetings, identifying members for presentation, and ensuring completion and documentation of follow‑up activities
坚定
Collaborate Behavioral Health to develop strategies and best practices that lead to desired goals and objectives for members who are co‑managed
Use expert verbal and non‑verbal communication skills to motivate and gain cooperation of members and their caregivers
Resolve issues and mitigate conflict encountered during daily operations, appropriately escalating issues to the Director of Medicaid
Identify and report potential risk, operational opportunities, and barriers encountered
Conduct monthly audits for the purpose of departmental/organizational reporting and providing formal feedback to case management staff
Create and submit operational weekly/monthly/quarterly reports
Work with the leadership team to develop and implement ongoing training and development efforts
Actively participate in staff training and meetings
Encourage regular communication and inform staff of relevant departmental and organizational updates
Develop and maintain collaborative relationships with clinical providers, facility staff and community resources
Ensure staff comply with orientation requirements, annual and other mandatory trainings, organizational and departmental policies, and procedures
Perform other duties as assigned by Director
bodaeth Minimum Qualifications
Bachelor'sொள்ள Degree required, Master's in nursing preferred
A minimum of 5 years of Care Management experience in a health care and/or Managed Care setting required
Minimum of 2 years managerial/leadership experience in a Managed Care and/or healthcare setting required
Proficiency with computers navigating in multiple systems and web‑based applications
Must know how to use Microsoft Office applications including Word, Excel, and PowerPoint and Outlook
Ability to proficiently read and interpret medical records, claims data, pharmacy and lab reports, and prescriptions required
Valid New York State license and current registration to practice as a Registered Professional Nurse (RN) issued by the New York State Education Department (NYSED)
Integrity and Trust
Customer Focus
Functional/Technical Skills
Confident, autonomous, solution driven, detail‑oriented, nonjudgmental, diplomatic, resourceful, intuitive, dedicated, resilient and proactive
Strong verbal and written communication skills including motivational coaching, influencing, and negotiation abilities
Holds themselves to high standards of excellence
Time management and organizational skills
Strong problem‑solving skills
Ability to prioritize and manage changing priorities under pressure geluk
Ability to work closely with member and caregiver
Ability to form effective working relationships with a wide range of individuals
#MPH50
#LI-Hybrid
Benefits NYC Health and Hospitals offers a competitive benefits package that includes:
Comprehensive Health Benefits for employees hired to work 20+ԥhrs. per week
Retirement Savings and Pension אתר Plans
Paid Holidays and Vacation in accordance with employees’ Collectively bargained contracts
Loan Forgiveness Programs for eligible employees \ầu College tuition discounts and professional development opportunities
College Savings Program
Union Benefits for eligible titles
Multiple employee discounts programs
Commuter Benefits Programs
#J-18808-Ljbffr
129643
Category:
Utilization Review and Case Management
Department:
CASE MANAGEMENT
Location:
50 Water Street, 7th Floor, New York, NY 10004
Job Type:
Regular
Employment Type:
Full-Time
Salary Range:
$123,588.00 - $123,588.00
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 Under the direction of the Director of Medicaid, the Medicaid Care Manager Team Lead ensures that staff adhere to the Medicaid contractual requirements, policies and procedures, and workflows established to manage the vulnerable Medicaid population.
The Medicaid Care Manager Team Lead manages the daily activities of the Medicaid team (Care Managers and Care Management Associates) to ensure quality outcomes in the delivery of member-centered case management including reduction in emergency room visits and hospital admissions, improved member satisfaction, improved member health, and cost effectiveness.
Work Shifts 9:00 A.M - 5:00 P.M
Duties & Responsibilities
Provide clinical guidance and supervision to assigned Care Managers and clinical support staff to promote efficient and effective delivery of care management services
Supervise day to day activities to make certain that case management services are provided in accordance with clinical guidelines, established processes and MetroPlusHealth organizational standards
Supervise the entire care management workflow including case referrals, assignments, interventions and goal setting, follow‑up/follow‑through activities, documentation, and escalations
Ensure care management activities are conducted in a safe, efficient, and effective manner to promote continuity and quality of care
Review, develop and modify day to day workflows to ensure timely follow‑up
Perform ongoing quality review of cases to ensure accuracy and compliance
Evaluate.includes staff performance; coach staff to improve both quality and quantity of skills attaining optimal performances
Utilize data to track, trend and report productivity and outcome measures, work with the management team to implement necessary improvement strategies
Coordinate Interdisciplinary Care Team rounds with providers, care managers and care management associates, this include scheduling meetings, identifying members for presentation, and ensuring completion and documentation of follow‑up activities
坚定
Collaborate Behavioral Health to develop strategies and best practices that lead to desired goals and objectives for members who are co‑managed
Use expert verbal and non‑verbal communication skills to motivate and gain cooperation of members and their caregivers
Resolve issues and mitigate conflict encountered during daily operations, appropriately escalating issues to the Director of Medicaid
Identify and report potential risk, operational opportunities, and barriers encountered
Conduct monthly audits for the purpose of departmental/organizational reporting and providing formal feedback to case management staff
Create and submit operational weekly/monthly/quarterly reports
Work with the leadership team to develop and implement ongoing training and development efforts
Actively participate in staff training and meetings
Encourage regular communication and inform staff of relevant departmental and organizational updates
Develop and maintain collaborative relationships with clinical providers, facility staff and community resources
Ensure staff comply with orientation requirements, annual and other mandatory trainings, organizational and departmental policies, and procedures
Perform other duties as assigned by Director
bodaeth Minimum Qualifications
Bachelor'sொள்ள Degree required, Master's in nursing preferred
A minimum of 5 years of Care Management experience in a health care and/or Managed Care setting required
Minimum of 2 years managerial/leadership experience in a Managed Care and/or healthcare setting required
Proficiency with computers navigating in multiple systems and web‑based applications
Must know how to use Microsoft Office applications including Word, Excel, and PowerPoint and Outlook
Ability to proficiently read and interpret medical records, claims data, pharmacy and lab reports, and prescriptions required
Valid New York State license and current registration to practice as a Registered Professional Nurse (RN) issued by the New York State Education Department (NYSED)
Integrity and Trust
Customer Focus
Functional/Technical Skills
Confident, autonomous, solution driven, detail‑oriented, nonjudgmental, diplomatic, resourceful, intuitive, dedicated, resilient and proactive
Strong verbal and written communication skills including motivational coaching, influencing, and negotiation abilities
Holds themselves to high standards of excellence
Time management and organizational skills
Strong problem‑solving skills
Ability to prioritize and manage changing priorities under pressure geluk
Ability to work closely with member and caregiver
Ability to form effective working relationships with a wide range of individuals
#MPH50
#LI-Hybrid
Benefits NYC Health and Hospitals offers a competitive benefits package that includes:
Comprehensive Health Benefits for employees hired to work 20+ԥhrs. per week
Retirement Savings and Pension אתר Plans
Paid Holidays and Vacation in accordance with employees’ Collectively bargained contracts
Loan Forgiveness Programs for eligible employees \ầu College tuition discounts and professional development opportunities
College Savings Program
Union Benefits for eligible titles
Multiple employee discounts programs
Commuter Benefits Programs
#J-18808-Ljbffr