Medicare Care Managment Team Lead
4 weeks ago
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 + HospitalsMetroPlusHealth 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 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 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.
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.
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.
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
- Supervise day to day activities to make certain that case management services are provided in accordance with clinical guidelines, established processed and MetroPlusHealth 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 include 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 trainings, organizational and departmental policies, and procedures.
- Perform other duties as assigned by Director.
- Bachelor’s Degree required; Masters preferred; and
- A minimum of 5 years of Case Management experience in a health care and/or Managed Care setting required; or
- An equivalent combination of training, educational background and experience in related fields and educational disciplines.
- Minimum of 2 years managerial/leadership experience in a Managed Care and/or health care setting required.
- Ability to proficiently read and interpret medical records, claims data, pharmacy and lab reports, and prescriptions required
- Ability to travel within the MetroPlusHealth service area making home visits to members, facility visits to clinical providers, and visits to community, faith and other social service-based agencies.
- Ability to work closely with member and caregiver.
- Ability to work in a facility-based environment collaborating with all levels of Health Care Providers, members, and families.
- Registered Nurse, Licensed Clinical Social Worker, or Licensed Master Social Worker with a current New York State License.
Professional Competencies
- 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.
- Ability to work closely with member and caregiver.
- Ability to form effective working relationships with a wide range of individuals.
#LI-Hybrid
-
Medicare Care Managment Team Lead
6 days ago
New York, New York, United States MetroPlusHealth Full timeEmpower. 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 + HospitalsMetroPlusHealth provides the highest...
-
Medicare Care Managment Team Lead
3 weeks ago
New York, United States MetroPlusHealth Full timeEmpower. 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 + HospitalsMetroPlusHealth provides the highest...
-
Medicare Care Managment Team Lead
3 weeks ago
New York, United States MetroPlusHealth Full timeEmpower. 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 + HospitalsMetroPlusHealth provides the highest...
-
Medicare Care Managment Team Lead
4 weeks ago
New York, United States MetroPlusHealth Full timeEmpower. 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 + HospitalsMetroPlusHealth provides the highest...
-
Medicare Care Managment Team Lead
4 weeks ago
New York, United States MetroPlusHealth Full timeEmpower. 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 + HospitalsMetroPlusHealth provides the highest...
-
Medicare Care Managment Team Lead
3 weeks ago
New York, United States MetroPlusHealth Full timeEmpower. 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 + HospitalsMetroPlusHealth provides the highest...
-
Medicare Care Managment Team Lead
4 weeks ago
New York, United States MetroPlusHealth Full timeEmpower. 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 + HospitalsMetroPlusHealth provides the highest...
-
Medicare Care Managment Team Lead
3 weeks ago
New York, United States MetroPlusHealth Full timeEmpower. 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 + HospitalsMetroPlusHealth provides the highest...
-
Medicare Care Managment Team Lead
3 weeks ago
New York City, United States MetroPlusHealth Full timeEmpower. 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 + HospitalsMetroPlusHealth provides the highest...
-
Medicare Care Managment Team Lead
2 weeks ago
New York City, United States MetroPlusHealth Full timeEmpower. 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 + HospitalsMetroPlusHealth provides the highest...
-
Medicare Benefit Advisor
2 weeks ago
New York, United States Village Care Full timeJob DescriptionJob DescriptionMedicare Benefit AdvisorTravel RequiredCOME WORK FOR THE LEADING, LOCAL MANAGED CARE COMPANY - VILLAGECARE!VillageCareMAX is looking for a motivated individual for this Full Time role as the Medicare Benefit Advisor. The Medicare Benefit Advisor is part of the VCMAX Business Development Team, and will be responsible for keeping...
-
Medicare Benefit Advisor
2 months ago
New York, United States Village Care Full timeJob DescriptionJob DescriptionMedicare Benefit AdvisorTravel RequiredCOME WORK FOR THE LEADING, LOCAL MANAGED CARE COMPANY - VILLAGECARE!VillageCareMAX is looking for a motivated individual for this Full Time role as the Medicare Benefit Advisor. The Medicare Benefit Advisor is part of the VCMAX Business Development Team, and will be responsible for keeping...
-
Medicare Benefit Advisor
3 weeks ago
New York, United States Village Care Full timeJob DescriptionJob DescriptionMedicare Benefit AdvisorTravel RequiredCOME WORK FOR THE LEADING, LOCAL MANAGED CARE COMPANY - VILLAGECARE!VillageCareMAX is looking for a motivated individual for this Full Time role as the Medicare Benefit Advisor. The Medicare Benefit Advisor is part of the VCMAX Business Development Team, and will be responsible for keeping...
-
Medicare Product Manager
5 days ago
New York, United States VIllageCare of New York Full time**MEDICARE PRODUCT MANAGER**: VillageCare has an exciting opportunity for a Full-Time Medicare Product Manager! This fully remote position allows you to work from the comfort of your own home while making a significant impact in the health care industry. You will have the chance to lead innovative projects and collaborate with a dynamic team to enhance...
-
Medicare Benefit Advisor
2 months ago
New York, United States Village Care Full timeJob DescriptionJob DescriptionMedicare Benefit Advisor - Cantonese/Mandarin/FujianeseTravel RequiredVillageCareMAX is looking for a motivated individual for this Full Time role as the Medicare Benefit Advisor. The Medicare Benefit Advisor is part of the VCMAX Business Development Team, and will be responsible for keeping the organization visible through new...
-
Medicare Benefit Advisor
3 weeks ago
New York, United States Village Care Full timeJob DescriptionJob DescriptionMedicare Benefit Advisor - Cantonese/Mandarin/FujianeseTravel RequiredVillageCareMAX is looking for a motivated individual for this Full Time role as the Medicare Benefit Advisor. The Medicare Benefit Advisor is part of the VCMAX Business Development Team, and will be responsible for keeping the organization visible through new...
-
Medicare Care Managment Team Lead
4 weeks ago
New York, NY, United States MetroPlusHealth Full timeEmpower. 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 + HospitalsMetroPlusHealth provides the highest...
-
Medicare Care Managment Team Lead
3 weeks ago
New York, NY, United States MetroPlusHealth Full timeEmpower. 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 + HospitalsMetroPlusHealth provides the highest...
-
Medicare Telesales Representative
2 weeks ago
New York, United States Village Care Full timeJob DescriptionJob DescriptionMEDICARE TELESALES REPRESENTATIVE112 Charles St.New York, NY 10014(Hybrid)Under the leadership of the Business Development/Training Manager, Sales Operations the Medicare Telesales Representative is responsible for providing positive, consistent, daily engagement via telephone with prospective members. The Representative will...
-
Medicare Benefit Advisor
3 weeks ago
New York, United States VIllageCare of New York Full time**Medicare Benefit Advisor** **Travel Required** COME WORK FOR THE LEADING, LOCAL MANAGED CARE COMPANY - VILLAGECARE! VillageCareMAX is looking for a motivated individual for this Full Time role as the Medicare Benefit Advisor. The Medicare Benefit Advisor is part of the VCMAX Business Development Team, and will be responsible for keeping the organization...
