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Medicaid Care Manager Team Lead
1 month ago
The Medicaid Care Manager Team Lead is responsible for ensuring that staff adhere to Medicaid contractual requirements, policies, and procedures, and workflows established to manage the vulnerable Medicaid population.
This role involves providing clinical guidance and supervision to assigned Care Managers and clinical support staff to promote efficient and effective delivery of care management services.
The successful candidate will have a strong background in care management, with a minimum of 5 years of experience in a healthcare and/or managed care setting.
Key responsibilities include:
- Supervising day-to-day activities to ensure that case management services are provided in accordance with clinical guidelines, established processes, and MetroPlus Health organizational standards.
- Ensuring care management activities are conducted in a safe, efficient, and effective manner to promote continuity and quality of care.
- Reviewing, developing, and modifying day-to-day workflows to ensure timely follow-up.
- Evaluating and documenting staff performance, coaching staff to improve both quality and quantity of skills.
- Utilizing data to track, trend, and report productivity and outcome measures.
- Collaborating with the management team to implement necessary improvement strategies.
The ideal candidate will possess strong problem-solving skills, ability to prioritize and manage changing priorities under pressure, and ability to work closely with members and caregivers.
Additionally, the successful candidate will have a strong understanding of the healthcare system, including Medicaid policies and procedures, and be able to communicate effectively with clinical providers, facility staff, and community resources.
This is a hybrid role, requiring occasional travel within the MetroPlus Health service area.
Minimum qualifications include a Bachelor's Degree, with a Master's preferred, and a minimum of 5 years of care management experience in a healthcare and/or managed care setting.
Preferred qualifications include a Registered Nurse with a current New York State License, and a minimum of 2 years of managerial/leadership experience in a managed care and/or healthcare setting.
Proficiency with computers, navigating in multiple systems and web-based applications, and ability to proficiently read and interpret medical records, claims data, pharmacy and lab reports, and prescriptions are also required.
NYC Health + Hospitals is an equal opportunity employer and welcomes applications from diverse candidates.
