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
MetroPlusHealth 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, MetroPlusHealth‘s network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlusHealth has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.
Position Overview
Under the supervision of the Senior Director of ICM, the Director of Medicaid will provide clinical and administrative oversight for the High-Risk Medicaid and PCS teams ensuring this vulnerable population receives the right care in the most appropriate setting. Manages the day-to-day operations of the clinical and
non-clinical staff ensuring adherence to regulatory requirements, established polices and workflows. The Director ofMedicaid ensures members are receiving the care they need, addressing their medical, behavioral, and social needs while ensuring appropriate linkages to services for them to remain safely in the community.
Job Description
- Participate in the development and articulates the vision and strategic direction for the care management of Medicaid members; collaborates on the implementation of strategies.
- Supervises, plans, organizes, prioritizes, delegates, and evaluates, staff and functions of the Medicaid and PCS teams.
- Maintains awareness and ensures compliance with NYS Medicaid contractual requirements for both PCS and mainstream member services
- Ensures staff adhere to the care management process of screening, assessing, implementing, and evaluating
- Monitors and audits the performance and productivity of the Medicaid teams
- In collaboration with Data Analytics evaluates the outcomes of the high-risk Medicaid team
- Provide clinical support for the review of Quality-of-Care concerns being investigated by the Quality Management Department.
- Must be familiar with OMH, DOH, CMS regulations for service delivery with a care coordination approach to service delivery in managed care settings.
- Collaborates with the UM Department to manage appropriate member utilization.
- Collaborates with MetroPlusHealth customer service department to ensure that member issues and concerns are addressed and resolved in a timely manner.
- Analyzes trends and implement departmental initiatives based upon data provided through the reporting of Care Management, Quality, Data Analytics and Audit data.
- Maintain communication with the department head, with routine updates on operations, issues, concerns, and other pertinent information.
- Perform other duties as assigned by the Senior Director.
Minimum Qualifications
- Bachelor’s Degree is required, Master’s Degree preferred
- Minimum 10 years professional healthcare management
- Must have 5 years or more in a leadership position in health-related setting
- Knowledge of care management process and managed care preferred.
- Ability to travel within the MetroPlusHealth service area, as needed
- Proficiency with the ability to read and interpret medical records, claims data, pharmacy and lab reports, and prescriptions required
Licensure and/or Certification Required
- Requires valid and current RN license to practice in the State of New York.
Professional Competencies
- Integrity and Trust
- Leadership and Management Skills
- Customer Focus
- Functional / Technical skills
- Written/ Oral Communication
- Ability to successfully multi-task while under strict timetable
- Exceptional Organizational skills
- Confident, autonomous, solution driven, detail oriented, high standards of excellence, nonjudgmental, diplomatic, resourceful, intuitive, dedicated, resilient and proactive
- Strong verbal and written communication skills including motivational coaching, influencing and negotiation abilities
- Excellent time management and organizational skills
- Strong problem-solving skills
- Ability to prioritize and manage changing priorities under pressure
- Proficiency with Microsoft Office applications including Word, Excel, PowerPoint, and Outlook.