Job Overview
Employment Type
Full-time
Compensation
Type:
Salary
Rate:
Range $160,000.00 - $170,000.00
Benefits
Health Insurance
Dental Insurance
Paid Time Off
retirement savings plan
hybrid work environment
Professional development opportunities
Employee wellness programs
Job Description
MetroPlusHealth is a leading healthcare organization committed to empowering New Yorkers through comprehensive, compassionate care. As a wholly-owned subsidiary of NYC Health + Hospitals—the largest public health system in the United States—MetroPlusHealth provides high-quality healthcare services across the five boroughs: Bronx, Brooklyn, Manhattan, Queens, and Staten Island. The organization offers a wide range of products including New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, and the Essential Plan. Serving over 30 years in the community, MetroPlusHealth has built strong relationships with its members and providers to support New Yorkers in living their... Show More
Job Requirements
- Bachelor of Science in Nursing required
- master’s degree in Nursing preferred
- minimum 10 years professional healthcare management experience
- minimum 5 years in leadership role, manager and above
- a minimum of 5 years of administrative experience with supervision of clinical and ancillary staff in a managed care role required
- must be familiar with OMH, DOH, CMS regulations for service delivery
- requires valid and current RN license to practice in the state of New York
- ability to maintain integrity and trust
- strong leadership and management skills
- customer-focused approach
- functional and technical competency
- excellent written and oral communication skills
- capability to multi-task under strict timetable
- exceptional organizational skills.
Job Qualifications
- Bachelor of Science in Nursing
- master’s degree in Nursing preferred
- minimum 10 years professional healthcare management
- minimum 5 years in leadership role, manager and above
- administrative experience supervising clinical and ancillary staff in managed care role
- familiarity with OMH, DOH, CMS regulations for service delivery
- care coordination approach to service delivery in managed care settings
- valid and current RN license to practice in the state of New York
- strong leadership and management skills
- integrity and trustworthiness
- customer focus
- functional and technical skills
- excellent written and oral communication
- ability to successfully multi-task under strict timetables
- exceptional organizational skills.
Job Duties
- Participates in the development of the vision and strategic direction for Integrated Care Management
- collaborates on the implementation of related strategies
- supervises, plans, organizes, prioritizes, delegates, and evaluates staff and functions of the Integrated Care Management Department and Medicare line of business
- ensure staff are care managing members in accordance with the risk stratification identified and adhering to the care management process of screening, assessing, implementing, and evaluating
- participates in development, implementation, and annual review of the Integrated Care Management and Quality Management/Quality Improvement Plan
- provides oversight for the implementation and adherence to the Model of Care
- ensures compliance with Federal, State and City regulations as they relate to Medicare, Medicaid, and Health Homes
- provides oversight for Transitions of Care Process and tracking, implementing strategies to prevent readmissions and reduce hospitalizations
- collaborates with NYC H+H and external partners on various initiatives, projects and pilot programs
- gathers, develops and tracks data on evidence-based practice interventions
- represents ICM at various meetings and committees as required
- provides clinical support for the review of Quality-of-Care concerns being investigated by the Quality Management Department, and collaborates with Quality Management on HEDIS, STAR ratings and CAHPS score improvement initiatives and strategies
- collaborates with the UM Department to manage appropriate member utilization and works with data analytics to generate reports that will illustrate the impact on members' utilization
- drives the implementation of processes and functional enhancements which will improve the overall quality and services provided by the CM teams
- collaborate with MetroPlusHealth customer service department to ensure that member issues and concerns are addressed and resolved in a timely manner
- analyzes trends and implements departmental initiatives based upon data provided through the reporting of Care Management or from Quality, Data Analytics and Audit data
- ensures comprehensive and supportive on-boarding of new hires and effective, data-driven monitoring/coaching to ensure that efficiency and performance are maximized among existing staff
- maintains communication with the department head, offering routine updates on operations, issues, concerns, and other pertinent information
- performs other duties as assigned by the Senior Director.
Job Location
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