Manager, Clinical Care Management RN (Garden City, NY)
HealthCare Partners, IPA and HealthCare Partners, MSO together comprise our health care delivery system providing enhanced quality care to our members, providers and health plan partners. Active since 1996, HealthCare Partners (HCP) is the largest physician-owned and led IPA in the Northeast, serving the five boroughs and Long Island. Our network includes over 6,000 primary care physicians and specialists delivering services to our 125,000 members enrolled in Commercial, Medicare and Medicaid products. Our MSO employs 200+ skilled professionals dedicated to ensuring members have access to the highest quality of care while efficiently utilizing healthcare resources.
HCP’s vision is to be recognized by members, providers and payers as the organization that delivers unsurpassed excellence in healthcare to the people of New York and their communities. We pride ourselves on selecting the most qualified candidates who reflect HCP’s mission of serving our members by facilitating the delivery of quality care. Interested in joining our successful Garden City Team? We are currently seeking a Manager of Clinical Care Management.
Position Summary: The Manager of Care Management has oversight for all aspects of the Care Management (CM) team, aimed at achieving long-term and short-term goals in a manner consistent with the mission, values and strategic goals of the organization. This position reports to the Vice President of Care Management, and provides leadership and oversight of clinical and non-clinical operations, analyzes utilization and performance trends while ensuring timely and cost effective delivery of care.
Essential Position Functions/Responsibilities:
- Lead a team of Nurse Care Managers for the managed services organization, directing various care management programs including Chronic Disease Program, Complex Case Management, Special needs Population, Coordination of Care and Transition of Care Programs.
- Audit and monitor CM team members’ work to ensure accuracy, timely processing, develop and implement training/retraining programs to address any gaps or new requirements.
- Responsible for departmental compliance with performance standards of various regulatory bodies including contracted Health Plans, Centers for Medicare and Medicaid Services (CMS), National Committee for Quality Assurance (NCQA), state, federal and Department of Labor.
- Work with leadership team to develop, update and implement CM policies, procedures and guidelines.
- Assist with CM audits, including document preparation and participation in on-site or remote audits, as a subject matter expert.
- Oversee CM team providing guidance and training as needed.
- Effectively manage a team to ensure a positive team environment, conduct performance reviews to provide feedback and opportunities for development.
- Responsible to ensure that all staff comprehend and comply with professional standards and internal process and procedures.
- Educate staff on relevant changes and developments in requirements or processes.
- Implement and monitor programs, including writing program descriptions, formulating annual reports, policies and procedures and Standard Operating Procedures.
- Responsible for the successful achievement of department goals and meeting or exceeding metrics/service level requirements.
- Development of internal audits to enhance compliance with contracted health plan and regulatory requirements.
- Contributory member of all Population Health focused Committees.
- Responsible for scheduled departmental reports.
- Participates in special projects as assigned.
- Effectively work with internal and external customers I.E. Pharmacy, Quality, Utilization Management, Compliance, and Provider Engagement and Customer Engagement Center.
Qualification Requirements:
Skills, Knowledge, Abilities
- Excellent oral, written communication and interpersonal prioritizing skills.
- Comprehensive knowledge of NCQA standards and other regulatory entities.
- Knowledge of CMS and health plan guidelines.
- Comprehensive knowledge of Care Management process and requirements.
- Excellent verbal presentation and problem solving skills.
- Strong analytical skills and ability to summarize findings succinctly.
- Ability to work independently in a detailed, deadline driven environment.
Training/Education:
- Bachelor of Science Degree in Nursing (BSN).
- Active unrestricted NYS RN License required.
Experience:
- Minimum of five (5) years’ clinical experience preferred.
- Minimum of three (3) years supervisory experience preferred.
- CM experience in a Managed Care setting preferred.
- UM experience in a managed care setting preferred.
Base Compensation: $125,000 - $145,000 annual
Bonus Incentive: Up to 10% of base salary
HealthCare Partners, MSO provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.
Department: Medical Management
This is a management position
This is a full time position
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