Medicare Care Manager Team Lead (RN/LMSW)

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 Medicare Care Manager Team Lead manages day to day activities of the Care Management (CM) team (RN/ SW Care Managers and Care Management Associates) to ensure quality outcomes such as reduction in emergency room visits and hospital admissions, improved member satisfaction, closing and reducing gaps in care, and cost effectiveness. This is accomplished through hands-on, participatory management where all aspects of day-to-day care 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 provides training, ongoing support, and mentorship to the CM team.

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

• Provide clinical guidance and supervision to assigned care managers and clinical support staff to promote efficient and effective delivery of care management services.
• Supervise day to day activities to make certain that care management services are provided in accordance with clinical guidelines, established processes and MetroPlus organizational standards.
• Ensure Medicare Model of Care (MOC) requirements are met and in compliance.
• Mentor and evaluate staff, problem solve and implement strategies to facilitate the overall goal of the program.
• Supervise the entire care management workflow including case selection, interventions and goal setting, follow-up/follow-through activities, documentation, and escalations.
• Ensure care 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 regulatory requirements and attainment of productivity and quality benchmarks.
• Perform ongoing quality review of cases and monthly chart review audits 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.
• Coordinate and manage the care management integrated care rounds, this includes scheduling meetings, preparing agenda, documentation of minutes and ensuring completion of follow up activities identified by the members of the team.
• Collaborate with other departments (i.e. Utilization management, Quality, Behavioral Health) to achieve optimal outcomes for members.
• Use expert verbal and non-verbal communications skills to motivate and engage members and their caregivers.
• Resolve issues and mitigate conflict encountered during daily operations; appropriately escalate issues to the Director of Integrated Care Management or Designee.
• Identify and report potential risk, operational opportunities, and barriers, proactively share with the leadership team.
• Conduct weekly and monthly audits for the purpose of departmental/organizational reporting and providing formal feedback to care 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 Medicare Care Manager Team Lead.
• Perform other duties as assigned by Director.

• Bachelor's degree in Nursing or Master's degree in Social Worker required.
• An equivalent combination of training, educational background and experience in related fields and educational disciplines. A minimum of 5 years of Case Management experience in a health care and/or Managed Care setting required.
• Minimum of 2 years managerial/leadership experience in a Managed Care and/or health care setting required.
• 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.
• 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 proficiently read and interpret medical records, claims data, pharmacy and lab reports, and prescriptions required.
• Ability to work closely with member and caregiver.
• Ability to collaborate with all levels of Health Care Providers, members and families.
• Ability to form effective working relationships with a wide range of individuals.
• Registered Nurse with a current New York State License or Licensed Social Worker

Professional Competencies

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

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