Director of Care Management
2 weeks ago
At MetroPlus Health Plan, we are committed to empowering New Yorkers by uniting communities through care. We believe that healthcare is a right, not a privilege. If you have compassion and a collaborative spirit, we invite you to join our team.
Job SummaryThe Director of Care Management provides clinical and administrative direction to Partnership in Care care management staff who are focused on providing high-quality clinical support and health education to members with HIV and those at risk of HIV infection. The successful candidate will coordinate program functions across MetroPlusHealth Medical Management, Operations, Finance, and Call Center Departments.
Key Responsibilities- Supervise and provide clinical and administrative oversight to Partnership in Care staff involved in care management activities.
- Promote and facilitate a multidisciplinary, data-driven approach to coordination of care and plan operations among disciplines.
- Lead interdisciplinary care rounds and conduct regular case reviews with care management staff of complex and/or high acuity cases.
- In collaboration with the Director of Community Outreach, Quality and Compliance, provide oversight and supervision of Partnership in Care program staff in the planning, development, implementation, and evaluation of quality improvement initiatives within the Partnership in Care program and within the Division of Medical Management.
- Ensure staff are fully trained and adherent to established documentation standards.
- In collaboration with the Director of Community Outreach, Quality and Compliance, contribute to the development and maintenance of an effective evaluation and monitoring system and utilize a variety of reports for staff coaching and program improvement.
- Collaborate with other organizational departments responsible for functional aspects of the HIV Special Needs Plan, including, but not limited to, Integrated Care Management, Behavioral Health, Managed Long-Term Care, Utilization Management, Quality Management, Credentialing, Regulatory Affairs, Compliance, Corporate Affairs, Provider Network Operations, Medicare Services, Information Systems, Finance, Claims, and Member Services and Eligibility.
- Bachelor's Degree from an accredited college or university is required. Master's Degree from an accredited college or university in Nursing, Social Work, or other healthcare-related discipline is preferred.
- A minimum of five years of progressive, professional experience in Nursing, Social Work, Health Care Administration, or other healthcare-related experience.
- A minimum of five years of administrative experience including supervision of staff from diverse professional backgrounds.
- Experience and knowledge of Managed Care, Case Management, and HIV care strongly preferred.
- Experience with developing and delivering staff trainings and in-services preferred.
- Bilingual (English/Spanish) preferred.
- New York State licensure as a Registered Professional Nurse, Nurse Practitioner, Physician Assistant, or Social Worker.
- Integrity and Trust
- Customer Focus
- Excellent interpersonal, organizational, verbal, and written communication skills.
- Proficiency with Microsoft Office.
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