Healthcare Manager

6 days ago

Queens, New York, United States Fidelis Care Full time
Job Summary

We are seeking a skilled Healthcare Manager to lead our LTSS Nurses team in delivering high-quality, cost-effective healthcare outcomes. As a key member of our team, you will be responsible for managing escalations and intake issues related to members or providers.

Key Responsibilities
  • Oversee and review intake required documentation to maintain compliance with federal and state regulations and contractual agreements.
  • Contribute to the development and implementation of policies and procedures within the Intake team based on regulatory requirements and industry standards.
  • Direct the daily activities of Intake staff, including reviewing and approving caseloads based on state requirements, Intake staff experience, and member needs.
  • Manage processes for escalation and/or complex cases, and provide guidance to team members to address member needs.
  • Manage or coordinate resolutions of member escalations and/or complaints and assist in audits and evaluations related to care programs and member concerns.
  • Contribute to the development, implementation, and oversight of intake programs to facilitate the use of appropriate services and resources.
  • Perform telephonic, digital, home, and/or other site outreach to assess member needs and collaborate with resources.
  • Set goals and objectives for Intake team and oversee intake data and reporting metrics to achieve quality and cost-effective healthcare results and work with senior leadership, as required.
  • Monitor audits within Intake to ensure compliance with regulatory requirements for federal, state, and National Committee for Quality Assurance (NCQA) standards, as required.
  • Provide feedback to intake team to improve member and provider experience and high-quality care.
  • Educate and provide resources for intake team on key initiatives and member outreach to facilitate ongoing communication between intake team, members, and providers.
  • Assist intake senior leadership with onboarding, hiring, and training intake team members.
  • Lead and champion change within scope of responsibility.
  • Perform other duties as assigned.
Requirements

Requires a Graduate from an Accredited School or Nursing or a Bachelor's degree and 5+ years of related experience. Master's degree preferred.

RN - Registered Nurse - State Licensure and/or Compact State Licensure required.

What We Offer

We offer a comprehensive benefits package including competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field, or office work schedules.

Centene is an equal opportunity employer that is committed to diversity and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

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