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.

Under the supervision of the Director of Long-Term Care Clinical Programs, the MLTC Care Manager Team Lead is responsible for the day-to-day supervision of a team of care managers within the MLTC department as they strive to keep our members safe and thriving at home. The Care Manager (CM) Team Lead provides comprehensive support and guidance on processes/workflows, identifies training needs, tracks and coaches on productivity, and ensures that high quality care management is delivered through call and chart audits. This position also conducts new hire onboarding and continued training for all clinicalMLTC/MAP staff, participates and interacts with all staff in a supportive role to ensure effective daily operations, and enhances communication and processes across the clinical and non-clinical areas of the department and between other departments. The position also oversees care management to members in
long-term care and utilization management of MLTC and personal care services (PCS) for Medicaid managed care.

Job Description

• Provides guidance to the CMs within the MLTC Department offering care management to members in several lines of business, particularly as it pertains to new processes and workflows
• which support program operations.
• Oversees utilization management of MLTC and PCS, including ensuring compliance with correct, timely review of cases and member/provider communication.
• Oversees daily monitoring of staff productivity and tracking of compliance with monthly member outreach calls and annual comprehensive, person-centered service plans.
• Oversees care coordination of members residing in and transitioning from skilled nursing facilities, and, in tandem with other MLTC colleagues, optimize the relationship with the nursing home staff to ensure open and productive collaboration.
• Promotes and facilitates a collaborative, multidisciplinary approach, supporting MLTC effective and coordinated care operations amongst disciplines/teams.
• Oversees clinical program training/retraining and creation and updating of departmental training tools and resources to support the delivery of high quality, efficient care management.
• Serves as a subject matter expert and training expert for Clinical Care Management processes and protocols in MetroPlusHealth Systems such as Care Connect, DCMS, Cisco, and all other programs which support MLTC operations.
• Oversees and monitors Care Managers' ACD activity and reporting.
• Conducts quality reviews of recorded calls and audits care management
• Works collaboratively with MLTC management team to ensure program goals, projects and initiatives are implemented following departmental workflows and policy standards.
• Works with the team to meet goals for performance improvement projects related to preventing
• falls and hospitalizations as well as initiatives to improve preventative care and meet other critical quality metrics among members in all lines of business.
• Supports Care Management staff as needed when management is in meetings and/or working on other program initiatives
• All other duties or actions as required under the direction of the MLTC management team.

Minimum Qualifications

• Bachelor's degree required; BSN preferred.
• 3-5 years of experience required in Care Management and/or Managed Care -
• Medicaid/MLTC/MAP
• Knowledge of MLTC program requirements required.
• Knowledge of long-term care settings.
• Experience as a user/reviewer of the UAS tool.
• Knowledge of utilization management processes; experience serving as a utilization
• management reviewer preferred.
• Proficiency with healthcare terminology such as ICD-10 codes, medical abbreviations.
• Prior People Leader experience (supervisory or managerial) preferred.

Licensure and/or Certification Required:

• NYS Registered Nurse (RN) license

Professional Competencies:

• Integrity and Trust
• Customer Service Focus
• Knowledge and expertise of computer systems, with proficiency in Microsoft
• office products.
• Excellent communication, interpersonal, written, and analytical skills.
• Strong organizational skills required.
• Microsoft Excel skills with the ability to edit, search, sort/filter, format/use styles, create tables,
• calculate data using functions and formulas and create/use PivotTables for analyzing data.