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Job Details

MLTC Team Leader

Job Ref: 45576
Category: Utilization Review and Case Management
Location: New York, NY
Job Type: Regular
Employment Type: Full-Time
Salary Range: $100,000.00 - $100,000.00

Marketing Statement

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 MLTC Clinical Program Manager, the CM-Team Leader is responsible for the supervision of the Care Managers (CM’s) operations within the MLTC department. The CM-Team Leader monitors the CM departmental ACD phone queue to ensure quality of calls between the care manager, members and providers. The Team Lead conducts new hire training and continued training for all clinical MLTC staff. The Team Leader participates and interacts with all staff in a supportive role as it relates to care management and coordination daily operations. The Team Leader will enhance communication and processes within the clinical and non-clinical areas within MLTC and between other internal operating departments.

Job Description

  • Provides guidance to the CM’s within the MLTC Department, particularly as it pertains to new processes and workflows which support program operations
  • Promotes and facilitates a multidisciplinary approach, supporting MLTC coordinated care operations amongst disciplines.
  • Oversee clinical program training/retraining and creation and updating of departmental training tools and resources.
  • SME and training expert for Clinical Care Management processes and protocol in MetroPlus Systems such as Care Connect, DCMS, Cisco, etc.; and all other programs which support MLTC operations.
  • Oversees and monitors Care Manager’ ACD activity and reporting.
  • 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
  • Supports Care Management staff as needed when management is in meetings and/or working on other program initiatives
  • All other duties or actions as required under the direction of the MLTC management team.

Minimum Qualifications

  • Registered Nurse, current New York State license, Bachelor’s degree (BSN)
  • preferred.
  • Previous Managed Care experience required in Medical Management Operations
  • and/or Care/Case Management.
  • Knowledge of MLTC program requirements required.
  • Experience user/reviewer of the UAS tool.
  • Prior supervisory or managerial experience preferred.
  • Excellent communication, interpersonal, written and analytical skills.
  • Knowledge of managed care practices and familiarity with MLTC DOH
  • requirements preferred.
  • Knowledge and expertise of computer systems, with proficiency in Microsoft
  • office products.
  • Strong organizational skills required. 
  • Microsoft Excel skills with the ability to edit, search, sort/filter, format/use styles, create tables, calculate data using functions and formulas and create/use PivotTables for analyzing data.
  • Proficiency with healthcare terminology such as ICD-9/10 codes, medical abbreviations.

Licensure and/or Certification Required

  • NYS Registered Nurse (RN) license.
  • Valid NYS driver’s license or NYS non-driver’s license ID (DMV Identification). If residing outside of NYS, candidate must obtain a NYS non-driver’s ID before commencement of employment.

Professional Competencies

  • Integrity and Trust
  • Customer Service Focus
  • Functional/Technical skills 
  • Written/Oral Communications

How To Apply

If you wish to apply for this position, please apply online by clicking the "Apply Now" button or forward your resume, noting the above Job ID #, to:

MetroPlus Health Plan
Human Resources Department
160 Water Street 8th Floor
New York, NY 10038
Attn: Recruitment Unit

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