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Director Care Management - Integrated Products

Job Category: Care Management

Location: New York, NY, United States

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Job Description

Description

The Director of Care Management at Healthfirst, in collaboration with the AVP of Care Management, will take independent ownership for responsibilities and oversight of the care management for all Members enrolled in one of our Integrated Products. This will include providing orientation and supervision to the Care Management Teams (CMT), their Supervisors and Managers as well as developing efficient and effective systems that will ensure and maintain a high level of quality care and compliance.

  • Provide a high level of supervision to and management support for Managers, Team Supervisors and the CMTs to ensure the best individualized care decisions, adherence to timely assessments and interventions for each member’s changing condition(s).
  • Participate in all aspects of personnel management to ensure appropriate staffing, orientation, support, corrective action, coaching/training plans and timely performance appraisals.
  • Coordinate with Contract Services to ensure an understanding of the MAP model of care and the care management process.
  • Enforce guidelines as mandated by CMS and New York State regulations, job aides and HF policies. This includes review of performance audit reports in order to maintain superior and accurate care data.
  • Manage patient/client information in a shared network environment using paperless database modules and archival systems.
  • Assist with budget planning, preparation and adherence.
  • Communicate with families, physicians, community providers and staff at all levels including the use of motivational tactics/tools.
  • Additional duties as assigned

Qualifications:

Minimum Qualifications:

  • A Licensed New York State RN with Bachelor’s Degree from and accredited institution or LMSW or LCSW is required. 

Preferred Qualifications: 

  • Advanced Degree.
  • Knowledgeable of Department of Health (DOH) and Center for Medicare & Medicaid Services (CMS) regulations.
  • Must have prior experience working with one or more Medicaid managed care plan products, such as FIDA, Medicaid Advantage Plus (MAP) and Managed Long Term Care (MLTC). .
  • Ability to interact and translate business needs in presentations across clinical and the larger organization. .
  • Knowledge and understanding of commercial populations.
  • Knowledge of National Committee for Quality Assurance (NCQA) accreditation requirements.
  • Ability to use Microsoft Excel to perform pivot tables, V-lookups and macros.
  • Ability to use PowerPoint to design, create hyperlinks, design, create graphics and convert spreadsheets.
  • Ability to analyze large amounts of data, interpret trends and drive process improvement across a multi-platform complex organization.    

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 [email protected] 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 Services.

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