- Supervise the day-to-day activities of the LTSS care management team to ensure quality outcomes (i.e., reduction in emergency room visits and hospital admissions, improved member satisfaction) and cost effectiveness. This is accomplished through hands-on, participatory management where all aspects of day-to-day case 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.
- Oversee the LTSS team which is comprised of Care Managers who are Registered Nurses and Licensed Social Workers as well as Care Management Associates and LTSS Coordinators.
- Ensures that staff adhere to the Medicaid contractual requirements, policies and procedures, and workflows established to manage the vulnerable Medicaid population.
- Facilitate the successful execution of LTSS services in collaboration with other departments 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 supportive 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, organizational standards and regulatory guidelines.
- Supervise the entire care management workflow including case assignment, interventions, goal setting, follow-up / follow-through activities, documentation, and escalations to ensure staff adhere to the care management process of screening, assessing, implementing, and evaluating.
- 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 Patient Centered Services Plans (PCSP) based on Uniform Assessment System (UAS) assessments and attainment of productivity benchmarks.
- 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.
- 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 Leadership.
- Conduct 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.
- Provide clinical support for the review of Quality-of-Care concerns being investigated by the Quality Management Department.
- Must be familiar with OMH, DOH, CMS regulations for service delivery with a care coordination approach to service delivery in managed care settings.
- Collaborates with the UM Department to manage appropriate member utilization.
- Collaborates with customer service department to ensure that member issues and concerns are addressed and resolved in a timely manner.
- Utilize data to analyze trends based upon data provided through the reporting of Care Management, Quality, Data Analytics and Audit data.
- Maintain communication with Director of Medicaid, with routine updates on operations, issues, concerns, and other pertinent information.
- Maintain professional competencies as a Manager of LTSS.
- Bachelor's degree is required, master's degree preferred; and
- Minimum of 7 years managerial / leadership experience in a Managed Care and / or health care community setting required; or
- Registered Nurse with a current New York State License.
- An equivalent combination of training, educational background and experience in related fields and educational disciplines.
- Proficiency with computers navigating in multiple systems and web-based applications.
- Proficient in Microsoft Office applications including Word, Excel, and PowerPoint and Outlook. Intermediate Excel Skills.
- 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.
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Description
Job Description
Job DescriptionFor 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.Manager of Long Term Services and Supports / Case Management / Manhattan, NY ( 2 days in the Manhattan office and 3 days remote )
Position Overview
#ZRCompany DescriptionRCM Health Care Services' mission is to provide opportunities for qualified candidates across medical professions. We deliver timely results and have built a reputation of trust with our clients and candidates. Since 1975, we have been providing staffing solutions to many of the finest healthcare institutions across the nation and careers for thousands of candidates. As professional career opportunity matchmakers, we follow up and follow through to help our clients and candidates to reach their career and life goals. We proudly hold the Joint Commission Gold Seal of Approval as well.
