MetroPlus Health Plan 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’ network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlus has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.
The Clinical Team Manager of MLTC, is responsible for supporting the day-to-day functions of the MLTC Care Management team, ensuring staff are adhering to policies and procedures, and that members needs are being met. The Manager will oversee the operations of the Care Management team including training, coaching, development, and evaluation of employee performance. Clinical Team Manager will analyze available data to measure individual and team performance, clinical program performance, department processes, and compliance.
The Clinical Team Manager will anticipate and resolve complex issues and ensure accurate and cost-effective operations. In addition to the day-to-day responsibilities, the Clinical Team Manager will work in conjunction with the Director of MLTC-PCS on a variety of critical tasks.
- Provide training and direction to support Care Managers and ensure that they are effectively completing assigned responsibilities; managing caseloads, interpreting regulations, policies, operational procedures and objectives; reviewing operations in assigned area to ensure a high level of quality that is consistent with organizational standards
- Participates in utilization review activities; perform case management analysis; and oversees concurrent review functions with appropriate follow-up action plan and intervention.
- Participate in activities to monitor compliance with service authorization regulations, the effectiveness of care plans and service provision guidelines, and their impact on outcomes.
- Review and approve the Care Management Team’s care plan and service plan development
- Develop and implement on-going staff training related to Care Management and ensure the appropriate tools are available for implementation of policies and procedures, documentation in MetroPlus’ member record, and measurement and reporting
- Facilitates requests from members for change in the care manager
- Identify areas for improvement of existing operational policies and procedures, develop recommendations to department senior management; and follow through with the implementation and continued monitoring
- In conjunction with the Director and other departmental managers, manage staff hiring, work allocation and scheduling, training and professional development, performance management, and related management activities
- Develop standards of staff performance and oversight to ensure performance indicator’s and program requirements are being met.
- Develop and initiate standards of performance, including communication with members, adherence to practice guidelines and care management protocols.
- Ensure care management compliance with NYSDOH MLTC program requirements.
- Update of the MLTC Member Handbook at least yearly and as needed based on regulatory changes and DOH notifications.
- Prepare data and written reports or materials for meetings and as required or requested by leadership.
- Actively participates in internal and external audits (DOH).
- Supports departmental quality improvement activities to improve program performance.
- Evaluates and assesses staff on an on-going basis, offering oral and written counseling as deemed required.
- Conducts departmental meetings and in-services associated with the implementation of new policies and procedures specific to MLTC.
- Leads the internal MLTC Operations meeting and actively participates in other committees where MLTC representation is needed/required.
- Performs other duties as necesscary
- Registered Nurse with a current licensure in NYS. Bachelor’s Degree required. Advanced degree preferred.
- A minimum of three years experience in a MCO setting, preferably with MLTC, Special Needs/LTHHCP/CHHHA or equivalent experience.
- Minimum of three years managerial experience.
- Excellent communication, written and analytical skills.
- Knowledge of computers and healthcare information systems.
- Highly organized skills required.
- Ability to work in a fast paced enviroments and technical clinicial expertise required.
- Experience with geriatric population
- Certification in Case Management
- Knowledge and expertise of care management-based computer systems and Microsoft office products.
- Experience with Medicaid recipients and community services
- Experience in managed care or care management
Licensure and/or Certification Required
- Registered Nurse with a current licensure in NYS
- Integrity and Trust
- Customer Focus
- Functional/Technical skills
- Written/Oral Communication