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Care Management Associate MLTC

Job Ref: 107440
Category: Professional
Location: 50 Water Street, 7th Floor, New York, NY 10004
Job Type: Regular
Employment Type: Full-Time
Hire In Rate: $50,000.00
Salary Range: $50,000.00 - $50,000.00

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.

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 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 Manager of MLTC-PCS Care Management Associates, the CMA Supervisor is responsible for the supervision of the Care Management Associates within the MLTC Department.  The CMA Supervisor monitors the CMA departmental ACD phone queue to ensure quality of calls between the Care Management Associates, members, and providers.  The CMA Supervisor conducts new hire training and continued training for all CMA MLTC/PCS staff.  The CMA Supervisor will enhance communication and processes for the non-clinical and clinical areas within MLTC/PCS and between other internal operating departments.

Job Description

  • Provides guidance to the CMAs within the MLTC Department, particularly as it pertains to new processes and workflows which support program operations.
  • Ensures the mailing of determination letters in accordance with mandated time constraints as applicable and conducts review prior to mailing.
  • Manage, analyzes, and coordinates the daily activities of the unit to ensure department productivity goals are met with regards to quality, timeliness, and accuracy.
  • Manages, directs, and develops staff by providing feedback and coaching.
  • Administers performance reviews for staff.
  • Ensures staff meets all regulatory requirements and comprehends and complies with best practices methodology, professional standards, and internal policies and procedures
  • Promotes and facilitates a multidisciplinary approach, supporting MLTC coordinated care operations across teams.
  • Oversee clinical program training/retraining and creation and updating of departmental training tools and resources.
  • Along with the Manager of MLTC-PCS CMAs, act as a subject matter and training expert for Care Management processes and protocol in the systems utilized by MLTC and all other programs which support MLTC operations.
  • Maintains a tracking tool which logs unacceptable inconsistencies and errors observed during quality reviews of recorded calls via the queue and care management documentation, care planning, follow up and interventions.
  • Works collaboratively with MLTC management team to ensure program goals, projects and initiatives are implemented and meet departmental workflows and policy standards.
  • Creates and champions a positive atmosphere within the team, fostering open communication, teamwork, ownership, and a collaborative environment to implement, optimize and share continuous improvement processes, both within the department and beyond it. 
  • Participates in staff meetings to offer ideas towards the enhancement of departmental processes
  • Oversees the authorization queue for MLTC to ensure regulatory compliance in meeting organizational determination timeframes.
  • Oversees and monitors the department phone queue and queue activity reporting; handles escalated calls by members and providers requiring intervention.
  • Investigates and resolves claims-related issues as needed.
  • Conducts all other duties or actions as required under the direction of the MLTC management team

Minimum Qualifications

  • Associate’s Degree required; or
  • High School Degree or evidence of having passed a High School Equivalency Program and 2 years of supervisory experience.
  • Bachelor’s Degree preferred
  • 2 years of experience in a managed care organization required; additional experience preferred
  • Good communication and interpersonal skills.
  • Understanding of medical terminology
  • General knowledge of managed care operational policies and procedures of the department
  • Excellent typing, computer literate (Microsoft Word, Excel, etc.)
  • Able to handle large volume of time-sensitive work
  • Basic working knowledge of computer systems

Professional Competencies

  • Integrity and Trust
  • Customer Service Focus
  • Functional/Technical skills
  • Written/Oral Communications
  • Dependable, reliable, and demonstrates good judgment ability.
  • Excellent organizational skills.