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Job Details

Sr Director of Integrated Case Management

Job Ref: 56312
Category: Utilization Review and Case Management
Location: 160 Water St. #3, New York, NY
Job Type: Regular
Employment Type: Full-Time
Hire In Rate: $160,000.00
Salary Range: $160,000.00 - $180,000.00

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 Deputy Chief Medical Officer, the Senior Director of Integrated Case Management (ICM) serves as the subject matter expert and resource for all departments related to care management activities. The Senior Director of ICM supports the mission of the plan by enhancing the quality of case management outcomes and member satisfaction, promotes continuity of care and cost effectiveness through the integration and functions of case management. The program provides intensive, personalized member-centered case management services and goal-setting for members who have complex medical needs and require a wide variety of resources to manage health and improve quality of life.

As a member of Medical Management Senior Leadership, the Senior Director of ICM is responsible for the day to day operations and human resource management of the Department of Case Management which includes Medicaid, Medicare and Medicare DSNP case management, high risk OB case management, the housing tasking force, Restricted Recipient Program and the Social Determinants of Health team. He/she serves as an educator, role model, member advocate, and change agent to enhance member care and staff competency. He/She collaborates with other departments (Utilization Management, Quality Management, HIV SNP, MLTC, Medical Directors, Customer Services, and other MetroPlus departments) to evaluate and coordinate activities and programs in support of delivery of member care. The Senior Director of ICM oversees daily team operations and provides strong leadership through training, coaching, teaching, and managing assigned teams.

Job Description

  • Provides clinical guidance and supervision to all care management programs, based on accepted principles of nursing, social work, gerontology, geriatrics and care management practice. 
  • Provides clinical perspective and best practices to staff through one-on-one coaching, group interaction at case conferences, in-service training, and other team meetings. 
  • Oversees and manages staff responsible for patient care coordination and management which includes nurses, licensed social workers, case management non-clinical staff and administrators. 
  • Monitors department activities to evaluate the productivity and quality of programs and processes to identify potential improvements and to ensure maximum performance. 
  • Develops and implements case management and disease management programs that meet the needs of our members. 
  • Manages and participates in departmental projects, workflow processes, policies and procedures in collaboration with internal and external stakeholders. 
  • Evaluates patient care data to ensure that care is provided in accordance with clinical guidelines and MetroPlus organizational standards. 
  • Ensures availability of specialized expertise to other MetroPlus programs by identifying case management needs and identifying and training subject matter experts. 
  • Ensures compliance with annual reporting requirement of New York State on case management services through New York State Department of Health Care Management Annual Reporting Tool (CMART) 
  • Develops and maintains professional networks and individual relationships with hospitals, physicians, and other providers to promote continuity and quality of care. 
  • Collaborates with staff and leadership to develop and implement systems that support operations and business goals within identified areas of responsibility. 
  • Uses a collaborative approach with the case management team and utilization management to revise, develop, and implement cost savings methodologies and interventions. 
  • Facilitates communication with providers to ensure continuity of care and coordination between multiple specialists, providers, and vendors. 
  • Enhances clinical quality of networked medical groups by training medical group staffs upon request. 
  • Recommends and participates in departmental policy and procedure development; and participates in internal and external committee meetings as they relate to case management activities. 
  • Acts as a resource and provides expert clinical opinions to all areas within the organization. 
  • Collaborates with Quality management to address suboptimal performance on QARR indicators and implement performance improvement projects 
  • Ensures that policies and procedures are developed and enforced in alignment with the standards of patient care and regulatory bodies and that the core components of the case management process are followed. 
  • Ensures case management team meets established performance metrics and performance guarantees. 
  • Updates and/or changes to the Case Management Program Description upon evaluation and review of member satisfaction and effectiveness data to address member needs. Evaluation results will be shared with staff and presented to the Quality Assurance Committee of MetroPlus Board of Directors on an annual basis. 
  • Adapts departmental plans and priorities to address business and operational challenges. 
  • Performs other duties as needed and assigned by the Deputy Chief Medical Officer relevant to Case Management activities. 

Minimum Qualifications

  • Licensure: RN or NP preferred. 
  • Minimum of 5 years managerial experience and leadership of a Case Management staff within a managed care organization or hospital environment. 
  • Strong knowledge of NYS Medicaid and CMS regulatory requirements
  • Knowledge of NCQA’s Case Management Accreditation Standards. 
  • Knowledge of standard case management concepts, practices and procedures in a managed care setting. 
  • Proficient in Microsoft Office; Strong analytical skills. 
  • Exemplary communication skills

Professional Competencies

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