The Manager of Care Management is responsible for supervising Care Management Teams (which includes RN's, Social Workers, and Coordinators) to coordinate appropriate services and care management to members while ensuring the mission of our program is maintained. The Manager will work on Healthfirst product lines such as FIDA, CompleteCare, Medicaid, Medicare, etc.
* Depending on one's residence and line of business, the Manager may be expected to make home, nursing home, and other related sites visits around downstate New York.
* Develops and monitors Care Management team goals; provides ongoing feedback and coaching; conducts annual performance reviews; leads by example; routinely evaluates staff's clinical skills and technical comprehension; and ensures an atmosphere of open communication, teamwork, and empowerment to make informed decisions * Maintains and recommends appropriate staffing levels to guarantee safe and effective care management * Oversees continuation, coordination, and delivery of individualized care plans and authorized services * Collaborates with other Care Management team members as needed * Assists in analyzing reviews, metric data, and PHI audits and uses that information to identify opportunities for improvement * Additional duties as assigned
* Associate's degree
* NYS RN * LSW or other relevant clinical license * CCM certification * Supervisory or training experience * Relevant clinical work experience * Knowledge of member satisfaction/incident management and regulations * Knowledge of quality improvement methodologies * Demonstrated professionalism and leadership skills along with ability to develop, direct, and support a team * Time management, critical/creative thinking, communication, and problem-solving skills * Adept at planning, organizing, and executing * Knowledge of health insurance, Medicaid, Medicare and MLTCP * Care management experience in a clinical managed care environment and knowledge of best practices * Knowledge of UM/QM case philosophies and reporting requirements to state and federal agencies * Ability to allocate, monitor, and control resources while delegating and monitoring workloads * Ability to effectively manage performance as well as set and achieve goals
Compliance & Regulatory Responsibilities:
* Ensures Care Management team meets department and regulatory requirements * Guarantees care plans are revised and updated according to regulatory requirements and as a member's condition(s) changes in the multiple PHI databases, especially TruCare. Supervises and audits compliance including HIPAA standards, for confidentiality and management of PHI plus Care Management Team entries in varied electronic PHI storage systems (e.g.: Macess, TruCare, and EMR).
WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.
If you have a disability under the Americans with Disability Act or a similar law, and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to ...@Healthfirst.org or calling 212-###-#### . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services.
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* The salary listed in the header is an estimate based on salary data for similar jobs in the same area. Salary or compensation data found in the job description is accurate.