The Manager of Care Management is responsible for supervising Care Management Teams (which includes RN’s, Social Workers, and Coordinators) to coordinate appropriate services and care management to members while ensuring the mission of our program is maintained. The Manager will work on Healthfirst product lines such as CompleteCare, Medicaid, Medicare, etc. *Depending on one’s residence and line of business, the Manager may be expected to make home, nursing home, and other related sites visits around downstate New York.

Duties/Responsibilities:

Develops and monitors Care Management team goals; provides ongoing feedback and coaching; conducts annual performance reviews; leads by example; routinely evaluates staff’s clinical skills and technical comprehension; and ensures an atmosphere of open communication, teamwork, and empowerment to make informed decisions
Maintains and recommends appropriate staffing levels to guarantee safe and effective care management
Oversees continuation, coordination, and delivery of individualized care plans and authorized services
Collaborates with other Care Management team members as needed
Assists in analyzing reviews, metric data, and PHI audits and uses that information to identify opportunities for improvement
Additional duties as assigned

Minimum Qualifications:
NYS RN,

LMSW or LCSW

Preferred Qualifications:
CCM certification
Supervisory or training experience
Relevant clinical work experience
Knowledge of member satisfaction/incident management and regulations
Knowledge of quality improvement methodologies
Demonstrated professionalism and leadership skills along with ability to develop, direct, and support a team
Time management, critical/creative thinking, communication, and problem-solving skills
Adept at planning, organizing, and executing
Knowledge of health insurance, Medicaid, Medicare and MLTCP
Care management experience in a clinical managed care environment and knowledge of best practices
Knowledge of UM/QM case philosophies and reporting requirements to state and federal agencies
Ability to allocate, monitor, and control resources while delegating and monitoring workloads
Ability to effectively manage performance as well as set and achieve goals

Compliance & Regulatory Responsibilities:
Ensures Care Management team meets department and regulatory requirements
Guarantees care plans are revised and updated according to regulatory requirements and as a member’s condition(s) changes in the multiple PHI databases, especially TruCare. Supervises and audits compliance including HIPAA standards, for confidentiality and management of PHI plus Care Management Team entries in varied electronic PHI storage systems (e.g.: Macess, TruCare, and EMR).

Since we care so greatly about our employees' and members' wellbeing, Healthfirst has implemented various COVID-related health and safety requirements for our workforce. Employees are expected to follow the Company’s current COVID-19 or other infectious disease health and safety protocols, including local requirements, which may include sharing information regarding your vaccine status and mask wearing. Protocols may change in the future with the evolving public health landscape. Healthfirst will consider accommodation requests as required by applicable law.

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability 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 careers@Healthfirst.org 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.

All hiring and recruitment at Healthfirst is transacted with a valid “@healthfirst.org” email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst.  Healthfirst will never ask you for money during the recruitment or onboarding process.