Director of Long Term Care Clinical Programs

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 's 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

The Director of Long Term Care Clinical Programs (formerly MLTC Clinical Programs) is responsible for supporting the day-to-day functions of the MLTC, MAP, and Nursing Home Care Management team, ensuring staff are adhering to policies and procedures, and that members needs are being met. The Director of Long Term Care Clinical Programs will be responsible for ensuring staff are meeting their goals, and that the necessary training, coaching, development, and evaluation of employee performance occurs.

• Oversee the Long Term Care Management team, comprised of a Manager, two Team Leads, and twentyone care managers for MLTC, MAP and nursing home members
• Provide training and direction to support to Manager, Team Leads and Care Managers, ensuring they are effectively completing assigned responsibilities; managing caseloads, correctly interpreting regulations, policies, operational procedures, and objectives; reviewing operations in assigned area to ensure a high level of quality that is consistent with organizational standards
• Participate in utilization review activities; perform case management analysis; and oversee concurrent review functions with appropriate follow-up action plan and intervention.
• Participate in activities to monitor compliance with service authorization regulations, the effectiveness of care plans and service provision guidelines, and their impact on outcomes.
• Provide feedback on the Care Management Team’s care plans and service plan development process to ensure they are evidence-based and meeting professional standards, both clinically and in terms of documentation
• Develop and implement on-going staff training related to Care Management and Utilization Management and ensure the appropriate tools are available for implementation of policies and procedures, documentation in MetroPlusHealth’s member record, and monitoring and reporting
• Facilitate requests from members for change in the care manager
• Identify areas for improvement of existing operational policies and procedures, develop recommendations to department senior management, and follow through with the implementation through continued monitoring
• In conjunction with the Senior Director and other departmental managers, manage staff hiring, work allocation and scheduling, training and professional development, performance management, and related management activities
• Develop standards of staff performance and oversight to ensure performance indicators and program requirements are being met.
• Develop and initiate standards of performance, including communication with members, adherence to practice guidelines and care management protocols.
• Ensure care management compliance with NYSDOH MLTC program requirements.
• Support the annual revision of the MLTC and MAP Member Handbooks or more often based on regulatory changes and DOH notifications.
• Prepare data and written reports or materials for meetings and as required or requested by leadership.
• Actively participate in internal and external audits as needed.
• Support departmental quality improvement activities to improve program performance.
• Evaluate and assess staff on an on-going basis, offering oral and written counseling as deemed required.
• Conduct departmental meetings and in-services associated with the implementation of new policies and procedures specific to MLTC, MAP and Medicaid Nursing Home members.
• Perform other duties as directed and as necessary.

• Bachelor’s Degree required. Advanced degree preferred.
• A minimum of six years’ experience in a MCO setting, preferably with MLTC, Special Needs/LTHHCP/CHHA or equivalent experience.
• Minimum of three years managerial experience.
• Knowledge of computers and healthcare information systems.
• Ability to work in a fast-paced environments and technical clinical expertise required.

Preferred Qualifications

• Experience with geriatric population
• Certification in Case Management
• Knowledge and expertise of care management-based computer systems and Microsoft office products.
• Experience with Medicaid recipients and community services
• Experience in managed care and/or care management

Licensure and/or Certification Required

• Registered Nurse with a current licensure in NYS

Professional Competencies:

• Integrity and Trust
• Customer Service Focus
• Functional/Technical skills
• Excellent communication, written and analytical skills.
• Highly organized skills required.
   

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