Senior Manager Clinical Eligibility Job at Healthfirst (New York)

Job Description

The Senior Mgr of Clinical Eligibility will have knowledge of the current assessment process, for both Medicaid and Medicare programs. This position will support the Assessment Managers in planning, directing, and implementing processes for successful outcomes and achieving goals. The Sr Mgr conducts and contributes to member and family education regarding health management and community resources to enhance population health. This position will be responsible for the overall administration, development, and operation of the Assessment team.

Job Responsibility

Participates in all aspects of personnel management to ensure appropriate staffing, orientation, support, discipline, and timely performance appraisals
Meets regularly with direct reports to review goals, trends, and performance measures and to facilitate change
Participates in continued staff development to improve the decision-making process
Provides administrative on-call coverage to troubleshoot and coordinate the delivery of care and services to members
Manages Assessment Managers to ensure timely assessments and targeted interventions to meet a member's changing condition(s)
Supports the care management teams to ensure effective care management and oversight of home vendor services
Supervises and directs the completion of assessments at established intervals to coincide with care plan development/revision and ensures early identification and action to address emergent issues
Assists members and prospective members with assessment and clinical eligibility questions
Coordinates with contract services to ensure understanding of the MLTC model, FIDA, MAP, and MMCP and cooperation with the assessment process
Ensures coordination with home health, nursing, and social work care as it relates to the care plan
Facilitates problem solving by coordinating case conferences and investigations with the care teams
Functions as a facilitator for the team and managers to ensure smooth workflow, efficiency and success within the four programs: PHSP, CC, AE, and SHP
Functions as a liaison to ensure process coordination with different organizational departments such as Intake/Medical Records/CMT/IT/HR/Marketing
Additional duties as assigned

Requirements

NYS licensed RN
Knowledgeable of state and federal regulations including experience interpreting those regulations as it pertains to different programs
Excellent interpersonal skills, especially relating well with a frail adult population, their families and community care providers, along with demonstrated ability to handle rapidly changing crisis situations while still achieving department goals and objectives
Understanding of and sensitivity to cultural differences and needs of the community are essential with a diverse and multi-cultural work environment and community of members such as Spanish, Chinese, Russian, Creole and Korean
Language preferences - Spanish, Russian, French, Creole, Mandarin, Cantonese
Bachelor's degree
Intermediate Microsoft Word, Excel, Outlook, Powerpoint, Access, Adobe, Visio, and project skills
Proficient navigating internet browsers, computer hardware, and multiple applications simultaneously, using encryption security tools, multiple electronic PHI databases, working in with a VPN and Citrix platform and very accurate typing skills
Demonstrated professionalism and leadership skills along with the ability to develop, direct, and support staff
Experience in home care environment, acute, sub-acute or long term care (LTC) setting or managed-long term care (MLTCP)
Experience in one of these areas: managed care organization, PACE, MLTCP, CHHA, licensed agency or a Lombardi program
Excellent communication, time management, writing, critical thinking, and problem solving skills
Supervisory, training, or management experience

Nice to have

Knowledgeable of state and federal regulations including experience interpreting those regulations as it pertains to different programs
Excellent interpersonal skills, especially relating well with a frail adult population, their families and community care providers, along with demonstrated ability to handle rapidly changing crisis situations while still achieving department goals and objectives
Understanding of and sensitivity to cultural differences and needs of the community are essential with a diverse and multi-cultural work environment and community of members such as Spanish, Chinese, Russian, Creole and Korean
Language preferences - Spanish, Russian, French, Creole, Mandarin, Cantonese
Bachelor's degree
Intermediate Microsoft Word, Excel, Outlook, Powerpoint, Access, Adobe, Visio, and project skills
Proficient navigating internet browsers, computer hardware, and multiple applications simultaneously, using encryption security tools, multiple electronic PHI databases, working in with a VPN and Citrix platform and very accurate typing skills
Demonstrated professionalism and leadership skills along with the ability to develop, direct, and support staff
Experience in home care environment, acute, sub-acute or long term care (LTC) setting or managed-long term care (MLTCP)
Experience in one of these areas: managed care organization, PACE, MLTCP, CHHA, licensed agency or a Lombardi program
Excellent communication, time management, writing, critical thinking, and problem solving skills
Supervisory, training, or management experience

What we offer

medical, dental and vision coverage
incentive and recognition programs
life insurance
401k contributions

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Senior Manager Clinical Eligibility

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