Clinical Program Manager
Job Ref: 45167
Category: Utilization Review and Case Management
Department: MANAGED LONG TERM CARE
Location: New York, NY
Job Type: Regular
Employment Type: Full-Time
Hire In Rate: $107,000.00
Salary Range: $107,000.00 - $107,000.00
MetroPlus Health Plan 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, MetroPlus’ network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlus has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.
The Clinical Program Manager of MLTC, oversees the administration of utilization management and care management activities, including care delivered in alternate care settings for members enrolled in MLTC program offered by MetroPlus Health Plan. The manager provides assistance in the administration of departmental activities and is responsible for the administration of operations and associated staff.
- The Clinical Manager will be actively involved in the Utilization & Care Management implementation of the MLTC program.
- The Clinical Manager will be responsible for recruiting new staff and documenting processes specific to the MetroPlus MLTC program.
- Assist in preparing the yearly budget for the department.
- Develop standards of staff performance and oversight to ensure performance indicator’s and program requirements are being met.
- Develop and initiate standards of performance, including communication with members, adherence to practice guidelines and care management protocols.
- Develop, updates and implements clinical program polices and workflows and monitors outcomes.
- Ensure care management compliance with NYSDOH MLTC program requirements.
- Update of the MLTC Member Handbook at least yearly and as needed based on regulatory changes and DOH notifications.
- Prepare data and written reports or materials for meetings and as required or requested by leadership.
- Actively participates in internal and external audits (DOH).
- Supports departmental quality improvement activities to improve program performance.
- Evaluates and assesses staff on an on-going basis, offering oral and written counseling as deemed required; incorporating all findings into annual performance evaluations.
- Conducts departmental meetings and in-services associated with the implementation of new policies and procedures specific to MLTC and FIDA lines of business.
- Assists with staff training as necessary.
- Leads the internal MLTC Operations meeting and actively participates in other committees where MLTC representation is needed/required.
- Performs other duties as directed and as necessary.
- Develop Community Resources and relationships that enhance the social wellbeing of the member and provide community support for the families.
- Maintain communication with State and other stakeholders and other health care providers.
- Accept speaking engagements representing MetroPlus and the MLTCP program.
- Attend committee meetings that further the knowledge, skills, abilities and goals of the MLTCP.
- Registered Nurse with a current licensure in NYS. Bachelors Degree required. Advanced degree preferred.
- A minimum of five years experience in a MCO setting, preferably with MLTC, Special Needs/LTHHCP/CHHHA or equivalent experience.
- Five years managerial experience.
- Excellent communication, written and analytical skills.
- Knowledge of computers and healthcare information systems.
- Highly organized skills required.
- Knowledge and expertise of care management based computer systems and Microsoft office products.
- Ability to work in a fast pace environments and technical clinical expertise required.
Licensure and/or Certification Required
- Registered Nurse with a current licensure in NYS
- Integrity and Trust
- Customer Focus
- Functional/Technical skills
- Written/Oral Communication