Hybrid - RN Director of Care Management - Managed Care MLTC
: Job Details :

Compass Healthcare Consulting & Placement is conducting a search for an experienced RN Director of Care Management, for a Healthcare organization with an office located in Midtown Manhattan, NY. This is an opportunity to support quality care, working with a team of clinical staff and healthcare leaders to achieve optimal patient outcomes. Registered Nurse, RN, with Managed Care Plan, MLTC, experience required. Qualified candidates will be an experienced Clinician, RN with a Managed Care Plan background, experienced in MLTC and/or Medicare Advantage Plans, with an emphasis on Care/Case Management and Manager level experience. Position is hybrid in nature, work from Manhattan office 3 days per week, and work from home 2 days per week.

Director of Care Management - RN

The RN Director of Care Management is responsible for providing management oversight and leadership to the Clinical Team Managers and their teams. The RN Director of Care Management assures direct management of all Service Level Agreements (SLA) to ensure plan contracts are in compliance.

Essential Job Duties

The RN Director of Care Management holds the managers and teams accountable for delivery of high quality community based member care through appropriate allocation of member services and resources. The RN Director of Care Management will be the lead interface between the company and Managed Care Plan s partnership team. This role is responsible for assuring that the Managers and care management teams adhere to the contracted MLTC s Program Policies and Procedures as outlined by NYS Department of Health.

Qualifications

• Licensed & Registered RN in the State of New York
• Bachelor's degree in Nursing, preferred.
• 5 years of healthcare experience, work within a Care Management and Managed Long Term Care setting, preferred.
• 3+years in a Supervisory role
• Certification and knowledge of UAS Assessment tool and documentation, preferred .
• Strong organizational and communication skills required.
• Managed Care (MLTC) / Care Management Experience Required
• Prior Director or Manager Level experience, preferred
• Ability to work in-office, Monday-Friday. Office in Midtown Manhattan, NY
• MS Office proficiency, excellent verbal and written communication, and the ability to work well under pressure required.
• Bi-lingual preferred

Job Responsibilities:

• Supervise Clinical Team Managers by providing day to day operational oversight of both clinical and non-clinical processes and procedures.
• Review Service Level Agreements (SLAs) and ensure all goals and metrics are met or exceeded.
• Oversee and provide guidance to the Managers for all Audits required both internally by Company and plan partners.
• Provides clinical direction, guidance, and problem solving to Clinical Managers regarding member care plan and service authorizations.
• Assures that CM Article 49 unit meets all MLTC benchmark metrics as outlined in the CM/UR QI plan.
• Oversees and assures communication as the lead interface between Company and contracted plan. Partnership with the team to address all issues and bring resolution to all inquiries.
• Cross Training for coverage of all plan care management contracts as part of the leadership team.
• Participates in the implementation and evaluation of the QI plan.
• Attends contract meetings as required and will support strategic growth for care management and UAS.
• Follow all agency policies and procedures.
• Maintains HIPAA compliance.
• All other duties as assigned.

Competitive salary and Compensation Package! $135-150k

Qualified Candidates Please Apply Now for Immediate Consideration!