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Director of Integrated Case Management

Job Ref: 63608
Category: Professional
Department: CASE MANAGEMENT PROGRAM
Location: 50 Water Street, 7th Floor, New York, NY 10004
Job Type: Regular
Employment Type: Full-Time
Hire In Rate: $160,000.00
Salary Range: $160,000.00 - $165,000.00

About NYC Health + Hospitals

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. 

Position Overview:

Under the supervision of the Senior Director of ICM, the Director of Integrated Case Management will provide clinical and administrative oversight for the ICM (Medicare), Medicaid  and PCS teams. This role ensures adherence to the Model of Care, regulatory requirements, established policies and workflows. Manages the day-to-day operations of the clinical and non-clinical staff ensuring adherence to the care management process. Most importantly, the Director ensures members are receiving the care they need, addressing their medical, behavioral and social needs while ensuring appropriate linkages in order for them to remain safely in the community and out of the inpatient setting.

Job Description

  • Participate in the development and articulates the vision and strategic direction for Integrated Care Management; collaborates on the implementation of strategies.
  • Supervises, plans, organizes, prioritizes, delegates and evaluates, staff and functions of the Integrated Care Management Department.
  • Ensures staff are care managing members in accordance with the risk stratification identified
  • Ensures staff are adhering to the care management process of screening, assessing, implementing and evaluating.
  • Participates in development, implements, and annually reviews the Integrated Care Management and Quality Management/Quality Improvement Plan.
  • Provides oversight for the implementation and adherence to the Model of Care
  • Ensures compliance with Federal, State and City regulations as they relate to Medicare, Medicaid and Health Homes.
  • Must be able to gather, develop and track data on evidence-based practice interventions.
  • Represents ICM at various meetings and committees as required.
  • 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 in order to manage appropriate member utilization.  
  • Drives the implementation of processes and functional enhancements which will improve the overall quality and services provided by the CM teams.
  • Collaborates with MetroPlus customer service department to ensure that member issues and concerns are addressed and resolved in a timely manner.
  • Analyzes trends and implement departmental initiatives based upon data provided through the reporting of Care Management, Quality, Data Analytics and Audit data.
  • Maintain communication with the department head, with routine updates on operations, issues, concerns, and other pertinent information.
  • Perform other duties as assigned by the Senior Director.

Minimum Qualifications

  • Master’s degree in Nursing, preferred
  • Minimum 10 years professional healthcare management
  • Minimum 5 years in leadership role, Manager and above
  • A minimum of 5 years of administrative experience with supervision of clinical and ancillary staff in a Managed care role required
  • Knowledge of Care Management Process

Licensure and/or Certification Required

  • Requires valid and current RN license to practice in the state of New York.

Professional Competencies

  • Integrity and Trust
  • Leadership and Management Skills
  • Customer Focus
  • Functional / Technical skills
  • Written/ Oral Communication
  • Ability to successfully multi-task while under strict timetable
  • Exceptional Organizational skills