Description and Requirements The Manager of Care Management is responsible for supervising a team (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 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 managementOversees continuation, coordination, and delivery of individualized care plans and authorized servicesCollaborates with each Clinical Operations’ core areas as neededAssists in analyzing reviews, metric data, and PHI audits and uses that information to identify opportunities for improvementAdditional duties as assigned

Minimum Qualifications:

For Medical Care Management:Associate’s degreeNYS RNLCSW or LMSW (any state)For Behavioral Health (BH) Care ManagementAssociate’s degreeNYS RN orLCSW, LMSW, LMFT, LMHC, LPC, or licensed psychologist (any state) For Peds Positions Only: The above licensure requirements + 1 year of pediatric clinical field experience, families and child serving systems, including child welfare and/or medically fragile/developmentally disabled populations.

Preferred Qualifications:

CCM certificationSupervisory or training experienceRelevant clinical work experienceKnowledge of member satisfaction/incident management and regulationsKnowledge of quality improvement methodologiesDemonstrated professionalism and leadership skills along with ability to develop, direct, and support a teamWork experience collaborating with multiple stakeholders to secure appropriate careTime management, critical/creative thinking, communication, and problem-solving skillsWork experience simultaneously navigating the internet and multi-tasking with multiple electronic documentation systemsAdept at planning, organizing, and executingKnowledge of health insurance, Medicaid, Medicare and MLTCPCare management experience in a clinical managed care environment and knowledge of best practicesWork experience requiring the ability to relate well with members, their families and community care providers, along with demonstrated ability to handling rapidly changing crisis situationsKnowledge of UM/QM case philosophies and reporting requirements to state and federal agenciesAbility to allocate, monitor, and control resources while delegating and monitoring workloadsAbility to effectively manage performance as well as set and achieve goals

Compliance & Regulatory Responsibilities:

Ensures Care Management team meets department and regulatory requirementsGuarantees 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).

Hiring Range*:

Greater New York City Area (NY, NJ, CT residents): $100,900 - $145,775

All Other Locations (within approved locations): $86,500 - $128,690

As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.

In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.

*The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role.