Medicaid Care Manager Team Lead Position
4 weeks ago
At NYC Health + Hospitals, we are committed to providing the highest quality healthcare services to our community. We are seeking a highly skilled and experienced Medicaid Care Manager Team Lead to join our team.
Job Summary:
The Medicaid Care Manager Team Lead will be responsible for ensuring that staff adhere to Medicaid contractual requirements, policies, and procedures. This includes managing the daily activities of the Medicaid team to ensure quality outcomes in the delivery of member-centered case management.
Key Responsibilities:
- Provide clinical guidance and supervision to assigned Care Managers and clinical support staff.
- Supervise day-to-day activities to ensure case management services are provided in accordance with clinical guidelines and MetroPlus Health 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, and coach staff to improve quality and quantity of skills.
- Utilize data to track, trend, and report productivity and outcome measures.
- Coordinate Interdisciplinary Care Team rounds with providers, care managers, and care management associates.
- Collaborate with Behavioral Health to develop strategies and best practices 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.
- Identify and report potential risks, operational opportunities, and barriers encountered.
- Conduct monthly audits for departmental/organizational reporting and provide 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.
Requirements:
- 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.
- Ability to proficiently read and interpret medical records, claims data, pharmacy, and lab reports, and prescriptions required.
- Ability to travel within the MetroPlus Health service area making home visits to members, facility visits to clinical providers, and visits to community, faith, and other social service-based agencies.
Licensure and/or Certification Required:
Registered Nurse with a current New York State License
Professional Competencies:
- Integrity and Trust
- Customer Focus
- Functional/Technical Skills
- Confident, autonomous, solution-driven, detail-oriented, non-judgmental, 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 members and caregivers.
- Ability to form effective working relationships with a wide range of individuals.
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