Director of Integrated Case Management for Medicare

Director of Integrated Case Management for Medicare

Job Ref : 130210

Category : Utilization Review and Case Management

Department : CASE MANAGEMENT

Location : 50 Water Street, 7th Floor,

New York,

NY 10004

Job Type : Regular

Employment Type : Full-Time

Salary Range : $155,000.00 - $170,000.00

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.

About NYC Health + Hospitals

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 supervision of the Senior Director of Integrated Care Management (ICM), the Director of ICM (Medicare) provides clinical and administrative oversight for the Medicare Advantage and Integrated Benefits for Dually Eligible ("IB-Dual") populations, also known as the Medicare dual eligible special needs plan (D-SNP) line of business. This role ensures adherence to the Medicare Model of Care, CMS regulatory requirements, established policies and workflows. They are also responsible for managing the day-to-day operations of the clinical and non-clinical staff, ensuring adherence to the care management process. Most broadly, the Director ensures members are receiving the care they need and that staff are addressing the members' medical, behavioral and social needs while ensuring appropriate linkages in order for them to remain safely in the community.

Work Shifts

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

Duties & Responsibilities

• Participates in the development of the vision and strategic direction for Integrated Care Management; collaborates on the implementation of related strategies.
• Supervises, plans, organizes, prioritizes, delegates, and evaluates staff and functions of the Integrated Care Management Department and Medicare line of business.
• Ensure staff are care managing members in accordance with the risk stratification identified and adhering to the care management process of screening, assessing, implementing, and

evaluating.

Ensures compliance with Federal, State and City regulations as they relate to Medicare,

Medicaid, and Health Homes.

STAR ratings and CAHPS score improvement initiatives and strategies.

Minimum Qualifications

A minimum of 5 years of administrative experience with supervision of clinical and ancillary

staff in a Managed care role required

Licensure and / or Certification Required :

Professional Competencies :

Benefits

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

#LI-Hybrid

#MHP50