Manager, Childrens Medical Care Management at Healthfirst

Remote
Healthfirst

Manager, Children’s Medical Care Management

Telecommute

Full time

R005901

The Manager of Children’s Care Management is responsible for supervising Care Management Teams 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 Medicaid and Child Health Plus.

  • Develops and monitors Care Management team goals
  • Provides ongoing feedback and coaching
  • Conducts performance reviews through routine evaluation of staff’s clinical skills and technical comprehension
  • Leads by example 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
  • 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 or LCSW, LMSW
  • 1 year of pediatric clinical field experience, families and child serving systems, including child welfare and/or medically fragile/developmentally disabled populations.
  • Proficient with simultaneously navigating the Internet and multi-tasking with multiple electronic documentation systems
  • Ability to collaborate with multiple stakeholders to secure appropriate care
  • Strong interpersonal skills, especially the ability to related well with children, their families and community care providers, along with demonstrated ability to handle rapidly changing crisis situations.

Compliance & Regulatory Responsibilities

  • Ensures Children’s 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

Preferred Qualifications:

  • Knowledge and experience with the current community health practices for the medically &/or emotionally fragile pediatric population.
  • Experience managing member information in a shared network environment using paperless database modules and archival systems.
  • Relevant work experience as a Care Manager in a clinical managed care environment and knowledge of best practices
  • Experience using Microsoft Office, SharePoint, TruCare & Interaction systems.
  • CCM certification
  • 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
  • Knowledge of health insurance, Medicaid and Child Health Plus
  • Knowledge of UM/QM case philosophies and reporting requirements to state agencies
  • Ability to allocate, monitor, and control resources while delegating and monitoring workloads

Minimum Qualifications:

  • Associate’s degree

Preferred Qualifications:

  • NYS RN
  • LSW or other relevant clinical license
  • 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).

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 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.

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