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Job Ref: 106332

Category: Managed Long Term Care

Department: CASE MANAGEMENT PROGRAM

Location: 50 Water Street, 7th Floor,

New York,
NY 10004


Job Type: Regular

Employment Type: Full-Time


Hire In Rate: $130,000.00



Salary Range: $130,000.00 - $140,000.00

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.

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 direction of the Director of Medicaid, the Manager of Long-Term Services and Supports (LTSS) will supervise the day-to-day activities of the LTSS care management team to ensure quality outcomes (i.e., reduction in emergency room visits and hospital admissions, improved member satisfaction) and cost effectiveness. This is accomplished through hands-on, participatory management where all aspects of day-to-day case management operations are supervised, and feedback is shared with the leadership team for the purpose of meeting program goals and the implementation of continuous quality improvement strategies.

The Manager of LTSS willoversee the LTSS team which is comprised of Care Managers who are Registered Nurses and Licensed Social Workers as well as Care Management Associates and LTSS Coordinators. The Manager of LTSS ensures that staff adhere to the Medicaid contractual requirements, policies and procedures, and workflows established to manage the vulnerable Medicaid population.

The Manager of LTSS will also facilitate the successful execution of LTSS services in collaboration with other departments to ensure the delivery of member-centered care management, improved access to community resources and improvement of overall health status of members.

• Provide clinical guidance and supervision to assigned Care Managers and clinical supportive staff to promote efficient and effective delivery of care management services.
• Supervise day to day activities to make certain that care management services are provided in accordance with clinical guidelines, established processes, MetroPlus organizational standards and regulatory guidelines.
• Supervise the entire care management workflow including case assignment, interventions, goal setting, follow-up/follow-through activities, documentation, and escalations to ensure staff adhere to the care management process of screening, assessing, implementing, and evaluating.
• Ensure care management activities are conducted in a safe, efficient, and effective manner to promote continuity and quality of care.
• Review, develop and modify day to day workflows to ensure timely completion of Patient Centered Services Plans (PCSP) based on Uniform Assessment System (UAS) assessments and attainment of productivity benchmarks.
• Perform ongoing quality review of cases to ensure accuracy and compliance.
• Evaluate and document staff performance; coach staff to improve both quality and quantity of skills attaining optimal performance.
• Utilize data to track, trend and report productivity and outcome measures; work with the management team to implement necessary improvement strategies.
• Use expert verbal and non-verbal communications skills to motivate and gain co-operation of members and their caregivers.
• Resolve issues and mitigate conflict encountered during daily operations; appropriately escalate issues to the Leadership.
• Conduct monthly audits for the purpose of departmental/organizational reporting and providing formal feedback to care management staff.
• Create and submit operational weekly/monthly/quarterly reports.
• Work with the leadership team to develop and implement ongoing training and development efforts.
• Actively participate in staff training and meetings.
• Encourage regular communication and inform staff of relevant departmental and organizational updates.
• Employ critical thinking and judgment when dealing with unplanned issues.
• Develop and maintain collaborative relationships with clinical providers, facility staff and community resources.
• Comply with orientation requirements, annual and other mandatory trainings, organizational and departmental policies, and procedures.
• 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.
• Utilize data to analyze trends based upon data provided through the reporting of Care Management, Quality, Data Analytics and Audit data.
• Maintain communication with Director of Medicaid, with routine updates on operations, issues, concerns, and other pertinent information.
• Maintain professional competencies as a Manager of LTSS.
• Perform other duties as assigned by Director of Medicaid

• Bachelor's degree is required, master's degree preferred; and
• Minimum of 7 years managerial/leadership experience in a Managed Care and/or health care community setting required; or
• An equivalent combination of training, educational background and experience in related fields and educational disciplines.
• Proficiency with computers navigating in multiple systems and web-based applications.
• Proficient in Microsoft Office applications including Word, Excel, and PowerPoint and Outlook.
• Ability to proficiently read and interpret medical records, claims data, pharmacy and lab reports, and prescriptions required.
• Ability to travel within the MetroPlusHealth service area, as needed.
• Ability to work closely with member and caregiver
• Registered Nurse with a current New York State License.

Professional Competences

• Integrity and Trust
• Customer Focus
• Functional/Technical skills
• Strong verbal and written communication skills including motivational coaching, influencing, and negotiation abilities.
• Holds themselves to high standards of excellence.
• Excellent time management and organizational skills with ability to successfully multi-task while under strict timetable
• Strong problem-solving skills.
• Ability to prioritize and manage changing priorities under pressure.
• Ability to form effective working relationships with a wide range of individuals.
• Confident, autonomous, solution driven, detail oriented, nonjudgmental, diplomatic, resourceful, intuitive, dedicated, resilient and proactive.

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