RCM Health Care Services New York, NY
For more than 30 years, this health plan has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life. They provide the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens, and Staten Island through a comprehensive list of products.
RN Team Leader (Case Management) Hybrid – Work from Home and if conditions improve may require 1 or 2 days a week in Manhattan Office.
Medicaid Care Manager Team Lead
Position Overview:
- Under the direction of the Director of Medicaid ICM, the Medicaid Team Leader ensures that staff adhere to the Medicaid contractual requirements, policies and procedures and workflows established to manage the vulnerable Medicaid population.
- The Team Leader manages the daily activities of the Medicaid team (Care Managers and Care Management Associates) to ensure quality outcomes i.e., reduction in emergency room visits and hospital admissions, improved member satisfaction and cost effectiveness.
- The Team Leader 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 care management, improved access to community resources and improvement of the overall health status of members.
- Job Description
- 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 case management services are provided in accordance with clinical guidelines, established processes and organizational standards.
- Supervise the entire care management workflow including case referrals, assignments, 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 follow up.
- 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.
- Coordinate Interdisciplinary Care Team rounds with providers, care managers and care management associates, this includes scheduling meetings, identifying members for presentation, and ensuring completion and documentation of follow up activities.
- Collaborate Behavioral Health to develop strategies and best practices that lead to desired goals and objectives for members who are co-managed.
- 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 Care Management.
- Identify and report potential risk, operational opportunities and barriers encountered.
- 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.
- Ensure staff comply with orientation requirements, annual and other mandatory trainings, organizational and departmental policies, and procedures.
Minimum Qualifications
- Bachelor’s Degree required; Masters preferred
- A minimum of 5 years of Care 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 form effective working relationships with a wide range of individuals.
- Registered Nurse with a current New York State License is required
Salary up to $110,000 with Generous Benefits (Pensions Plan)