MetroPlus Health Plan 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, MetroPlus’ network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlus has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.
Under the direction of the CM Operations Manager or Designee, the Team Leader manages day to day activities of the case management PCS 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. The Team Leader for PCS spends approximately 20% of the time in the field to provide on the job training, supervise visits, ongoing support and mentorship.
The Team Leader facilitates the successful execution of PCS services in accordance with regulatory guidelines by providing day to day supervision and applying problem solving skills to ensure the delivery of member-centered care management, improved access to community resources and improvement of overall health status of members.
This is a hands on, involved, contractual program and will require ongoing oversight both on the unit and in the field; hence will require some travel within the MetroPlus Health Plan service area.
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, MetroPlus organizational standards and regulatory guidelines.
Conduct periodic field visits (at minimum twice per month) to mentor and evaluate staff, problem solve and implement strategies to facilitate the overall goal of the program.
Supervise the entire care management workflow including case assignment, interventions, goal setting, follow-up/follow-through activities, documentation and escalations.
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 UAS reviews, creation of Patient Centered Services Plans (PCSP) 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 Care Management Operations Manager or Designee.
Identify and report potential risk, operational opportunities and barriers encountered in the field, proactively share with the leadership team.
Conduct monthly audits for the purpose of departmental/organizational reporting and providing formal feedback to case 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.
Maintain professional competencies as a Team Leader.
Perform other duties as assigned by Manager.
Clinical background: Registered Nurse licensure required
Bachelor’s Degree required, Masters preferred
An equivalent combination of training, educational background and experience in related fields and educational disciplines. A minimum of 5 years of Case Management experience in Managed Care and/or health care community setting (i.e. Lombardi, MLTC) required.
Minimum of 2 years managerial/leadership experience in a Managed Care and/or health care community setting required.
Proficiency with computers navigating in multiple systems and web based applications
Confident, autonomous, solution driven, detail oriented, high standards of excellence, nonjudgmental, diplomatic, resourceful, intuitive, dedicated, resilient and proactive
Strong verbal and written communication skills including motivational coaching, influencing and negotiation abilities
Excellent time management and organizational skills
Strong problem solving skills
Ability to prioritize and manage changing priorities under pressure
Proficient in Microsoft Office applications including Word, Excel, and PowerPoint and Outlook.
Ability to proficiently read and interpret medical records, claims data, pharmacy and lab reports, and prescriptions required
Ability to travel within the MetroPlus service area making home visits to members, facility visits to clinical providers, and visits to community, faith and other social service based agencies.
Ability to work closely with member and caregiver.
Ability to work in a facility based environment collaborating with all levels of Health Care Providers, members and families.
Ability to form effective working relationships with a wide range of individuals.
Licensure and/or Certification Required
Registered Nurse with a current New York State License.
Integrity and Trust
How To Apply
If you wish to apply for this position, please apply online by clicking the "Apply Now" button or forward your resume, noting the above Job ID #, to:
MetroPlus Health Plan
Human Resources Department
160 Water Street 8th Floor
New York, NY 10038
Attn: Recruitment Unit
This is a unionized position, in addition to a variety of options for Health Benefits through MetroPlus, unionized employees are eligible for vision, dental, life insurance, prescription drug coverage and more through their designated union.