Medicare Care Managment Team Lead (RN)

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

Under the direction of the Senior Director of Integrated Case Management or Designee, the Medicare Care Manager Team Lead manages day to day activities of the case management team (Case Managers and Case Management Associates) to ensure quality outcomes (i.e., reduction in emergency room visits and hospital admissions, improved member satisfaction) and cost effectiveness. This is accomplished through hands-on, participatory management where all aspects of day-to-day case 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 spends approximately 80% of the time in the field to provide on the job training, supervise visits, ongoing support and mentorship.

The Medicare Care Manager Team Lead facilitates the successful execution of the Integrated Case Management program by providing day to day supervision and applying problem solving skills to ensure the delivery of member- centered case management, improved access to community resources and improvement of overall health status of members.

• Provide clinical guidance and supervision to assigned Case Managers and Case Management Associates in order to promote efficient and effective delivery of case management services.
•  Supervise day to day activities in the field to make certain that case management services are provided in accordance with clinical guidelines, established processes and MetroPlus organizational standards.
• Conduct 4 – 5 field visits per day to mentor and evaluate staff, problem solve and implement strategies to facilitate the overall goal of the program.
• Supervise the entire case management workflow including case selection, interventions and goal setting, follow-up/follow-through activities, documentation, and escalations.
• Ensure case 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 visits and attainment of productivity benchmarks.
• Perform ongoing quality review of cases 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.
• Use expert verbal and non-verbal communications skills to motivate and gain co-operation of members and their caregivers.
• Resolve issues and mitigate conflict encountered during daily operations; appropriately escalate issues to the Sr. Director of Case Management or Designee.
• Identify and report potential risk, operational opportunities and barriers encountered in the field, proactively share with the leadership team.
• Conduct monthly audits for the purpose of departmental/organizational reporting and providing formal feedback to case 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 trainings, organizational and departmental policies, and procedures.
• Maintain professional competencies as a Team Lead.
• Perform other duties as assigned by Manager.

• Bachelor’s Degree required; Masters preferred; and
• A minimum of 5 years of Case Management experience in a health care and/or Managed Care setting required; or
• An equivalent combination of training, educational background and experience in related fields and educational disciplines. 
• Minimum of 2 years managerial/leadership experience in a Managed Care and/or health care setting required.
• Ability to proficiently read and interpret medical records, claims data, pharmacy and lab reports, and prescriptions required
• Ability to travel within the MetroPlusHealth service area making home visits to members, facility visits to clinical providers, and visits to community, faith and other social service-based agencies.
• Ability to work closely with member and caregiver.
• Ability to work in a facility-based environment collaborating with all levels of Health Care Providers, members, and families.
• Registered Nurse, Licensed Clinical Social Worker, or Licensed Master Social Worker with a current New York State License.

Professional Competencies 

• Integrity and Trust
• Customer Focus
• Functional/Technical Skills
• Written/Oral Communications
• Strong verbal and written communication skills including motivational coaching, influencing and negotiation abilities
• Excellent time management and organizational skills
• Strong problem-solving skills
• Ability to prioritize and manage changing priorities under pressure
• Proficient in Microsoft Office applications including Word, Excel, and PowerPoint and Outlook.
• Ability to form effective working relationships with a wide range of individuals.
• 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

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