Medicare Care Manager Team Lead

Job Ref: TE0184
Category: Utilization Review and Case Management
Department: CASE MANAGEMENT
Location: 50 Water Street, 7th Floor, New York, NY 10004
Job Type: Regular
Employment Type: Full-Time
Work Arrangement: Hybrid
Salary Range: $111,306.00 - $111,306.00

Position Overview 

Under the direction of the Director of Integrated Care Management-Medicare, the Medicare Care Manager Team Lead ensures that staff adhere to the Medicare Model of Care requirements, policies, procedures and workflows established to manage the Medicare Dual Eligible Special Needs Plan (D-SNP) population.

The Medicare Care Manager Team Lead manages day-to-day activities of the Care Management (CM) team (RN/ SWCare Managers and Care Management Associates/Personal Health Coaches) to ensure quality outcomes such as reduction in emergency room visits and hospital admissions, improved member satisfaction, closing and reducing gaps in care, and cost effectiveness. This is accomplished through hands-on, participatory management where all
aspects of day-to-day care 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
Medicare Care Manager Team Lead provides training, ongoing support, and mentorship to the CM team. The Medicare Care Manager Team Lead facilitates the successful execution of the Integrated Care Management
program by providing day-to-day supervision and applying problem solving skills to ensure the delivery of membercentered care management, improved access to community resources and improvement of overall health status of
members.

Scope of Role & Responsibilities

• Provide clinical guidance and supervision to assigned care managers and clinical support 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 and MetroPlus organizational standards.  
• Ensure Medicare Model of Care (MOC) requirements are met and in compliance.
• Mentor and evaluate staff, problem solve and implement strategies to facilitate the overall goal of the program.
• Supervise the entire care management workflow including case selection, interventions and goal setting, follow-up/follow-through activities, documentation, and escalations. 
• 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 regulatory requirements and attainment of productivity and quality benchmarks.
• Perform ongoing quality review of cases and monthly chart review audits 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. 
• Coordinate and manage the care management integrated care rounds, this includes scheduling meetings, preparing agenda, documentation of minutes and ensuring completion of follow up activities identified by the members of the team.  
• Collaborate with other departments (i.e. Utilization management, Quality, Behavioral Health) to achieve optimal outcomes for members.
• Use expert verbal and non-verbal communications skills to motivate and engage members and their caregivers.
• Resolve issues and mitigate conflict encountered during daily operations; appropriately escalate issues to the Director of Integrated Care Management or Designee.
• Identify and report potential risk, operational opportunities, and barriers, and proactively share with the leadership team. 
• Conduct weekly and 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 training, organizational and departmental policies, and procedures.  
• Maintain professional competencies as a Medicare Care Manager Team Lead. 
• Perform other duties as assigned by Director.

Required Education, Training & Professional Experience

• Bachelor’s degree in Nursing or Master’s degree in Social Work required.
• A minimum of 5 years of Case Management experience in a health care and/or Managed Care setting required.
• Minimum of 2 years managerial/leadership experience in a Managed Care and/or health care setting required.
• Proficiency with computers navigating in multiple systems and web-based applications.
• Ability to prioritize and manage changing priorities under pressure.
• Ability to proficiently read and interpret medical records, claims data, pharmacy and lab reports, and prescriptions required.
• Ability to work closely with members and caregivers.
• Ability to collaborate with all levels of Health Care Providers, members and families.
• Ability to form effective working relationships with a wide range of individuals.
• Must know how to use Microsoft Office applications including Word, Excel, PowerPoint and Outlook.

Licensure and/or Certification Required

• Valid New York State license and current registration to practice as a Registered Professional Nurse
(RN), Licensed Master Social Worker (LMSW) or Licensed Clinical Social Worker (LCSW) issued by
the New York State Education Department (NYSED).

Professional Competencies

• Integrity and Trust
• Customer Focus
• Functional/Technical skills
• Proficiency with computers navigating in multiple systems and web-based applications.
• 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.
• Time management and organizational skills
• 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.

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