Available Positions

Manager, Medical Management at Health Care Company in Brooklyn, New York, United States —

  • Healthcare
  • Health Care Company
  • Brooklyn, New York, United States
  • 11/15/19

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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