Director of Care Management (PIC)

MetroPlusHealth • Full-time • New York • 1m ago

Empower. Unite. Care.

MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day.

About NYC Health + Hospitals

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

Under the direction of the Medical Director for Partnership in Care (PIC), the Director of Care Management (PIC) provides clinical and administrative direction to Partnership in Care care management staff who are focused on providing high quality clinical support and health education to members with HIV and those at risk of HIV infection to ensure these members receive the best possible care and achieve optimal health and wellness. The Director of Care Management (PIC) coordinates program functions across MetroPlusHealth Medical Management, Operations, Finance, and Call Center Departments.

Job Description

Supervise and provide clinical and administrative oversight to Partnership in Care staff involved in care management activities.
Promote and facilitate a multidisciplinary, data-driven approach to coordination of care and plan operations among disciplines. Ensure that standards of HIV care and chronic care delivery models and standards for Plan operations are consistent with the organization’s model of care, current professional standards, prevailing evidence-based practices, compliant with Federal, State and City regulations, and consistent with the mission, vision and values of the organization.
Lead interdisciplinary care rounds and conduct regular case reviews with care management staff of complex and/or high acuity cases. Lead engagement with clinical facilities and providers to optimize the management of members with complex care needs.
In collaboration with the Director of Community Outreach, Quality and Compliance, provide oversight and supervision of Partnership in Care program staff in the planning, development, implementation, and evaluation of quality improvement initiatives within the Partnership in Care program and within the Division of Medical Management.
Ensure staff are fully trained and adherent to established documentation standards.
In collaboration with the Director of Community Outreach, Quality and Compliance, contribute to the development and maintenance of an effective evaluation and monitoring system and utilize a variety of reports for staff coaching and program improvement.
Collaborate with other organizational departments responsible for functional aspects of the HIV Special Needs Plan, including, but not limited to Integrated Care Management, Behavioral Health, Managed Long-Term Care, Utilization Management, Quality Management, Credentialing, Regulatory Affairs, Compliance, Corporate Affairs, Provider Network Operations, Medicare Services, Information Systems, Finance, Claims, and Member Services and Eligibility.
Participate in committees, as assigned.

Minimum Qualifications

Bachelor's Degree from an accredited college or university is required. Master's Degree from an accredited college or university in Nursing, Social Work, or other healthcare-related discipline is preferred.
A minimum of five years of progressive, professional experience in Nursing, Social Work, Health Care Administration, or other healthcare-related experience.
A minimum of five years of administrative experience including supervision of staff from diverse professional backgrounds.
Experience and knowledge of Managed Care, Case Management, and HIV care strongly preferred.
Experience with developing and delivering staff trainings and in-services preferred.
Bilingual (English/Spanish) preferred.

Licensure and/or Certification Required: