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Care Management Supervisor

Req #: 107584
Job Location(s): Brooklyn, NY
Zip Code: 11220
Category: Management - Clinical
Agency: Elderplan
Status: Regular Full-Time
Office: Office-based

The challenges of affordable healthcare continue to create new opportunities. Elderplan and HomeFirst, our Medicare and Medicaid managed care health plans, are outstanding examples of how we are expanding services in response to our patients' and members' needs. These high-quality healthcare plans are designed to help keep people independent and living life on their own terms.

Why work for MJHS?:

When you work with us you will receive comprehensive and affordable health and financial benefits, in addition to generous paid vacation, personal and holiday time that you won't find at our competitors. Do you receive a paid day off for your birthday now? No?  You will here!  You will also receive the training, tuition assistance and career development you desire to help you achieve your career goals.  You take care of our patients, residents and health plan members, and we will take care of the rest!

 

Benefits include:

  • Sign-on Bonuses OR Student Loan Assistance for clinical staff
  • FREE Online RN to BSN and MSN degree programs!
  • Tuition Reimbursement for all full and part-time staff
  • Dependent Tuition Reimbursement for clinical staff!
  • Generous paid time off
  • Affordable medical, dental and vision coverage for employee and family members
  • Two retirement plans! 403(b) AND Employer Paid Pension
  • Flexible spending
  • And MORE!

Responsibilities:

  • Oversees the management of member care with members and their families and coordinates with the PCP, SCP and all of the health care team facilitating the members care across the continuum of care.
  • Assigns cases to care managers according to pre-established criteria and guidelines.
  • Oversees timely scheduling of visits for CAF, Re-CAF and follow up visits or calls.
  • Evaluates PRI, CAF, and Re-CAF for NHC eligibility.
  • Evaluates completion of RECAF/CAF and supervises implementation of care plan and chronic care benefit.
  • Acts as a resource to staff reviewing cases and making recommendations for changes in member care practices.
  • Supervises the assessment of the members physical, psycho-social and discharge planning needs through communication with appropriate health care team.
  • Ensures compliance with 95% or greater of all documentation/input of CAF findings, care plan and progress notes and all interventions and authorizations, encounters with providers, members and vendors are documented in the Amisys case record in accordance with established standards.
  • Provides reports necessary to monitor/track operational efficiency and effectiveness of operational processes.
  • Ensures all employees are oriented to their department/agency and job and provided with appropriate training, development and continuing education.
  • Correctly interprets and applies all Human Resources policies and procedures relative to discipline, recruitment and selection, performance appraisals, salary reviews and staffing.
  • Identifies potential risk issues and contributing factors in all areas of patient care, safety and legal matters, including potential for adverse publicity.

Qualifications:

  • Master of Social Work Degree or related field, or RN
  • Minimum one to three year previous management experience preferred
  • Previous managed care experience in the areas of utilization management and/or case management required
  • Working knowledge of Windows, Word, Excel. Current NYS CSW, CCM preferred
  • Excellent customer service, oral communication, writing, and typing skills
  • Ability to demonstrate effective critical thinking and problem solving skills
  • Excellent telephone assessment skills
  • Working knowledge of utilization management processes
  • Knowledge of Federal and State regulations, managed care regulations and concepts, and CQI methodologies

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