For more than 30 years, this health plan has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life. They provide the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens, and Staten Island through a comprehensive list of products.

Medicaid Care Manager RN Team Lead – Manhattan, NY ( 2 days in the Manhattan office and 3 days remote )
Ensures that staff adhere to the Medicaid contractual requirements, policies and procedures, and workflows established to manage the vulnerable Medicaid population.
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.
Job Description

• Provide clinical guidance and supervision to assigned Care Managers and clinical support staff to promote efficient and effective delivery of care management services
• Provide clinical guidance and supervision to assigned Care Managers and clinical support staff to promote efficient and effective delivery of care management services
• Provide clinical guidance and supervision to assigned Care Managers and clinical support staff to promote efficient and effective delivery of care management services.
• 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 processed and organizational standards.
• Supervise the entire care management workflow including case referrals, assignments, interventions and goal setting, follow-up/follow-through activities, documentations, 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 and document 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 includes scheduling meetings, identifying members for presentation, and ensuring completion and documentation of follow up activities.
• 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 co-operation of members and their caregivers.
• Resolve issues and mitigate conflict encountered during daily operations, appropriately escalate 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 training, organizational and departmental policies, and procedures.

Minimum Qualifications

• Bachelor’s Degree required, Master’s 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 computer navigating in multiple systems and web-based applications.
• Must know how to use Microsoft Office applications including Word, Excel, PowerPoint, and Outlook.
• Ability to proficiently read and interpret medical records, claims data, pharmacy and lab reports, and prescriptions required.
• Ability to travel within the service area making home visits to members, facility visits to clinical providers, and visits to community, faith, and other social service-based agencies.
• Registered Nurse with a current New York State license is required.

Salary Range $105,000 to $110,000 with Excellent Benefits (Pension Plan)

INDP

Job Type: Full-time

Pay: $100,000.00 - $110,000.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday

Work setting:

• Office

Work Location: In person