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Medicaid Care Manager Team Lead
2 months 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 Medicaid Care Manager Team Lead will oversee the daily activities of the Medicaid team, ensuring quality outcomes in the delivery of member-centered case management. This includes reducing emergency room visits and hospital admissions, improving member satisfaction, and promoting cost-effectiveness.
Key Responsibilities- 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 ensure case management services are provided in accordance with clinical guidelines, established processes, and MetroPlus Health Plan organizational standards.
- 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.
- Evaluate and document staff performance; coach staff to improve both quality and quantity of skills attaining optimal performance.
- Utilize data to track, trend, and report productivity and outcome measures, working with the management team to implement necessary improvement strategies.
- Coordinate Interdisciplinary Care Team rounds with providers, care managers, and care management associates, including scheduling meetings, identifying members for presentation, and ensuring completion and documentation of follow-up activities.
- Collaborate with 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 cooperation of members and their caregivers.
- Resolve issues and mitigate conflict encountered during daily operations, appropriately escalating 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 the Director.
- Bachelor's Degree required, Master's preferred.
- A minimum of 5 years of Care Management experience in a healthcare and/or Managed Care setting required.
- Minimum of 2 years managerial/leadership experience in a Managed Care and/or healthcare setting required.
- Proficiency with computers navigating in multiple systems and web-based applications.
- Must know how to use Microsoft Office applications including Word, Excel, and PowerPoint and Outlook.
- Ability to proficiently read and interpret medical records, claims data, pharmacy and lab reports, and prescriptions required.
- Ability to travel within the MetroPlus Health Plan service area making home visits to members, facility visits to clinical providers, and visits to community, faith, and other social service-based agencies.
- Registered Nurse with a current New York State License.
