Clinical Navigation Team Mgr Care Mgmt

The Manager of Care Management is responsible for supervising a team (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, 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.

Duties/Responsibilities:

·        Develops and monitors 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 each Clinical Operations’ core areas as needed

·        Assists in analyzing reviews, metric data, and PHI audits and uses that information to identify opportunities for improvement

·        Additional duties as assigned

 

Minimum Qualifications:

·        Associate’s degree

·        NYS RN, LSW or other relevant clinical license

 

Preferred Qualifications:

·        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.  HF Management Services, LLC complies with all applicable laws and regulations. Applicants and employees are considered for positions and are evaluated without regard to race, color, creed, religion, sex, national origin, sexual orientation, pregnancy, age, disability, genetic information, domestic violence victim status, gender and/or gender identity or expression, military status, veteran status, citizenship or