Manager, Care Management LTC

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:

• For Medical Care Management:
  • Associate’s degree
  • NYS RN
  • LCSW or LMSW (any state)

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
• Work experience collaborating with multiple stakeholders to secure appropriate care
• Time management, critical/creative thinking, communication, and problem-solving skills
• Work experience simultaneously navigating the internet and multi-tasking with multiple electronic documentation systems
• 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
• Work experience requiring the ability to relate well with members, their families and community care providers, along with demonstrated ability to handling rapidly changing crisis situations
• 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 race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability 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 careers@Healthfirst.org or calling 212-519-1798 . 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 Ser