Manager of Care Management

MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlusHealth network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlusHealth has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.

Position Overview:

Empower. Unite. Care.

MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day.

Under the supervision of the Director of Care Management, the Manager of the Partnership in Care (PIC) Department Care Management program will serve as the subject matter expert and resource for all care management activities within PIC. The Manager of Care Management supports the mission of the plan by enhancing the quality-of-care management outcomes and member satisfaction, promotes continuity of care and cost effectiveness through the integration and functions of care management. The program provides intensive, personalized member-centered care management services and goal setting for members who are living with HIV and have complex medical needs and require a wide variety of resources to manage health and improve quality of life.

As a member of the PIC Department Leadership, the Manager of Care Management is responsible for the day-to-day operations in Partnership in Care Department. The Manager of Care Management serves as an educator, role model, and change agent to enhance member care and staff competency. The Manager collaborates with other departments (Utilization Management, Quality Management, Integrated Care Management, Managed Long-Term Care, Personal Care Services, Restrictive Recipient Program, Customer Success, and other MetroPlusHealth departments) to evaluate and coordinate activities and programs in support of delivery of member care. The Manager of Care Management oversees daily team operations and provides strong leadership through training, coaching, teaching, and managing assigned team.

• Provides clinical guidance and supervision to all care management programs, based on accepted principles of nursing, social work, gerontology, geriatrics, HIV care and care management practice.
• Provides clinical perspective and best practices to staff through one-on-one coaching, group interaction at case conferences, in-service training,
• Oversees and manages staff responsible for patient care coordination and management which includes Health and Wellness Advisors Levels I and II.
• Conduct monthly audits of teams and shares findings during supervision to promote accuracy and compliance.
• Mentor Health and Wellness Advisors Levels I and II.
• Problem solves and addresses care issues requiring escalation in a manner that fosters member satisfaction and promotes quality care and service delivery.
• Develops and conducts comprehensive onboarding for newly hired and existing staff.
• Monitors department activities to evaluate the productivity and quality of programs and processes to identify potential improvement opportunities and to drive towards optimal performance.
• Actively participates in the development of care management and disease management programs that meet the needs of our members.
• Ensures new and existing programs are implemented as designed and make recommendations for continuous quality improvement.
• Manages and participates in departmental projects, workflow processes, policies, and procedures in collaboration with internal and external stakeholders.
• Evaluates patient care data to ensure that care is provided in accordance with clinical guidelines and MetroPlusHealth organizational standards.
• Develops and maintains professional networks and individual relationships with hospitals, physicians, and other providers to promote continuity and quality of care.
• Collaborates with staff and leadership to develop and implement systems that support operations and business goals within identified areas of responsibility.
• Uses a collaborative approach with the care management team and utilization management to revise, develop, and implement cost savings methodologies and interventions.
• Facilitates communication with providers to ensure continuity of care and coordination between multiple specialists, providers, and vendors.
• Participates as an integral part of member interdisciplinary care teams to ensure compliance with Medicare model contract.
• Participates in quarterly interdisciplinary rounds with designated virology sites
• Recommends and participates in departmental policy and procedure development; and participates in internal and external committee meetings as they relate to care management activities.
• Collaborate with Behavioral Health to develop strategies and best practices that lead to desired goals and objectives for members who are co-managed.
• Collaborates with Quality Management to address suboptimal performance on HEDIS/QARR indicators and implement performance improvement projects.
• Ensures that policies and procedures are developed and enforced in alignment with the standards of patient care and regulatory bodies and that the core components of the care management process are followed.
• Ensures Care Management team meets established performance metrics and performance guarantees.
• Performs other duties as needed and assigned by the Medical Director relevant to Care Management activities.

• Bachelor's degree from an accredited college or university in a healthcare-related field is required. Master's degree from an accredited college or university in Nursing, Social Work or other healthcare related discipline is preferred.
• Minimum of 5 years of Case Management experience.
• Minimum of 3 years of managerial experience and leadership in a Case Management role within a managed care organization or hospital setting preferred
• Knowledge of NCQA's Case Management Accreditation Standards.
• Proficiency in Microsoft Office and strong data analytical skills.

Licensure and/or Certification Required:

• New York State license as Registered Nurse or License Social Worker required.
• Certified Case Manager (CCM) preferred.

Professional Competencies:

• Integrity and Trust
• Customer Focus
• Functional/Technical Skills
• Written/Oral Communications