Manager, Medical Management at Health Care Company in Brooklyn, New York, United States —
- Healthcare
- Health Care Company
- Brooklyn, New York, United States USA
- 6/22/20 2020-06-22
Job ID: 33925
Job Description
Oversee either Medicare Advantage/FIDA
Manage the care management or utilization management teams to ensure that standards for service delivery and team/staff performance are met or exceeded
Participate in internal and external marketing and provider relations
Review specific utilization or care management issues with interdisciplinary team
Investigate, analyze and report to Medical Management leadership on the facts related to member complaints, incidents, or challenging member issues
Monitor care or utilization management processes with the Clinical Evaluation Managers (CEM) and the interdisciplinary team to ensure cost effective quality outcomes
Participates in development and implementation of the Quality Assurance and Compliance initiatives
Act as resource for the CEM staff and facility discharge planning staff to prepare for hospital discharge
Facilitate scheduled Clinical Rounds
Generate care management reports via the care/utilization management systems and demonstrate competency as a super user of these systems
Evaluate staff performance
Hire, promote, and terminates staff, and recommends salary actions, as appropriate
Qualifications
Bachelor’s Degree or equivalent work experience in management for a health plan or utilization/case management required
License and current registration to practice as a registered professional nurse in New York State required
4+ years of experience in home care, care management or related field, including
3+ years of progressive experience in case or utilization Management, required
Supervisory experience in MLTC - MAP (Medicare Advantage) or FIDA
Case Management Certification preferred
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