Medicaid Care Manager RN Team Lead / Hybrid

Job ID: 259474    Posted 5/16/2024


Location: New York, New York


Job Type: Direct Hire


Category: Case Management


Position: 259474


Skills: Medicaid


Salary Low: $100000 - Salary High: $110000


Duration: 2 Weeks



Job Description

For 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.

Medicaid Care Manager RN Team Lead – Manhattan, NY ( 2 days in the Manhattan office and 3 days remote )
Ensures that staff adhere to the Medicaid contractual requirements, policies and procedures, and workflows established to manage the vulnerable Medicaid population.
Manages the daily activities of the Medicaid team (Care Managers and Care Management Associates) to ensure quality outcomes in the delivery of member-centered case management including reduction in emergency room visits and hospital admissions, improved member satisfaction, improved member health, and cost effectiveness.
Job Description

  • Provide clinical guidance and supervision to assigned Care Managers and clinical support staff to promote efficient and effective delivery of care management services
  • Provide clinical guidance and supervision to assigned Care Managers and clinical support staff to promote efficient and effective delivery of care management services.
  • Supervise day to day activities to make certain that case management services are provided in accordance with clinical guidelines, established processed and organizational standards.
  • Supervise the entire care management workflow including case referrals, assignments, interventions and goal setting, follow-up/follow-through activities, documentations, 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 follow up.
  • 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 performances.
  • Utilize data to track, trend and report productivity and outcome measures, work with the management team to implement necessary improvement strategies.
  • Coordinate Interdisciplinary Care Team rounds with providers, care managers and care management associates, this includes scheduling meetings, identifying members for presentation, and ensuring completion and documentation of follow up activities.
  • Collaborate Behavioral Health to develop strategies and best practices that lead to desired goals and objectives for members who are co-managed.
  • Use expert verbal and non-verbal communication 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 Director of Medicaid
  • Identify and report potential risk, operational opportunities, and barriers encountered.
  • 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.
  • Develop and maintain collaborative relationships with clinical providers, facility staff and community resources.
  • Ensure staff comply with orientation requirements, annual and other mandatory training, organizational and departmental policies, and procedures.

Minimum Qualifications

  • Bachelor’s Degree required, Master’s preferred.
  • A minimum of 5 years of Care Management experience in a health care and/or Managed Care setting required.
  • Minimum of 2 years managerial/leadership experience in a Managed Care and/or healthcare setting required.
  • Proficiency with computer navigating in multiple systems and web-based applications.
  • Must know how to use Microsoft Office applications including Word, Excel, PowerPoint, and Outlook.
  • Ability to proficiently read and interpret medical records, claims data, pharmacy and lab reports, and prescriptions required.
  • Registered Nurse with a current New York State license is required.

Salary Range $105,000 to $110,000 with Excellent Benefits (Pension Plan)

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At RCM Health Care Services, we redefine healthcare staffing, creating an environment where your career thrives and flourishes. Our commitment to your success is woven into the fabric of our culture, offering diverse opportunities for both seasoned professionals seeking challenges and newcomers ready to make their mark. As a part of the RCM family, you'll experience more than just a job – you'll find a platform for continuous growth and fulfillment.

We have cultivated an ecosystem where healthcare professionals not only find rewarding career opportunities but also a community that values their skills and dedication. Your success is our priority, and our collaborative environment ensures you're never alone on your professional journey. Competitive salaries and comprehensive benefits reflect our dedication to your well-being, allowing you to focus on what matters most – delivering exceptional care. Join RCM Health Care Services, a trusted partner with a proven track record since 1975 and embark on a journey where your path to a fulfilling healthcare career truly begins.

About Us

With a legacy spanning over 45 years, RCM Health Care Services is a leader in connecting healthcare professionals with rewarding career opportunities. Our foundation is built on cultivating relationships with school districts, setting the stage for our expansion into placing providers across diverse facility types. As we evolved, our expertise diversified across various divisions including School Services, Behavioral Health/ABA, Travel, Nursing, Therapy, HIM, Permanent Placement, Foreign Recruitment, Locums Tenens, and much more.
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