Medicaid Care Manager Team Lead Registered Nurse

MetroPlus Health 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, MetroPlus Health 's network includes over 27,000 primary care providers, specialists and participating clinics. For more than 40 years, MetroPlus Health has been committed to building strong relationships with its members and providers.

Position Overview

Under the direction of the Director of Medicaid, the Medicaid Care Manager Team Lead ensures that staff adhere to the Medicaid contractual requirements, policies and procedures, and workflows established to manage the vulnerable Medicaid population.

The Medicaid Care Manager Team Lead manages the daily activities of the Medicaid team (Care Managers and Care Management Associates) to ensure quality outcomes in the delivery of member-centered case management including reduction in emergency room visits and hospital admissions, improved member satisfaction, improved member health, and cost effectiveness.

Work Shifts

9 : 00 A.M - 5 : 00 P.M

Duties & Responsibilities

• Provide clinical guidance and supervision to assigned Care Managers and clinical support staff to promote efficient and effective delivery of care management services
• Supervise day to day activities to make certain that case management services are provided in accordance with clinical guidelines, established processed and MetroPlusHealth organizational standards.
• Supervise the entire care management workflow including case referrals, assignments, interventions and goal setting, follow-up / follow-through activities, documentations, and escalations.
• 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.
• Perform ongoing quality review of cases to ensure accuracy and compliance.
• Evaluate and document staff performance; coach staff to improve both quality and quantity of skills attaining optimal performances.
• Utilize data to track, trend and report productivity and outcome measures, work with the management team to implement necessary improvement strategies.
• Coordinate Interdisciplinary Care Team rounds with providers, care managers and care management associates, this include scheduling meetings, identifying members for presentation, and ensuring completion and documentation of follow up activities.
• Collaborate Behavioral Health to develop strategies and best practices that lead to desired goals and objectives for members who are co-managed.
• Use expert verbal and non-verbal communication skills to motivate and gain co-operation of members and their caregivers.
• Resolve issues and mitigate conflict encountered during daily operations, appropriately escalate issues to the Director of Medicaid
• Identify and report potential risk, operational opportunities, and barriers encountered.
• Conduct monthly audits for the purpose of departmental / organizational reporting and providing 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.
• Perform other duties as assigned by Director.

Minimum Qualifications

#MPH50

#LI-Hybrid

Benefits

NYC Health and Hospitals offers a competitive benefits package that includes :