Care Manager RN (High Risk OB)

MetroPlus Health Plan • New York, NY, US • 4d ago

Job Ref: 121172
Category: Utilization Review and Case Management
Department: CASE MANAGEMENT PROGRAM
Location: 50 Water Street, 7th Floor, New York, NY 10004
Job Type: Regular
Employment Type: Full-Time
Hire In Rate: $108,815.00
Salary Range: $108,815.00 - $108,815.00

Empower. Unite. Care.

MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day.

About NYC Health + Hospitals

MetroPlusHealth 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, MetroPlusHealth network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlusHealth has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.

Position Overview

Under the direction of the Director of Complex Care & Social Determinants of Health, the High-Risk Obstetrics (HROB) Team Lead ensures that staff adhere to the policies and procedures and workflows established to manage the High-Risk Obstetric population. The Team Lead manages the daily activities of the HROB Care Management Team (Care Managers and Care Management Associates) to ensure quality outcomes i.e., full term deliveries, reduction of infants requiring NICU stays and improved member satisfaction and cost effectiveness. The Team Lead facilitates the successful execution of the Integrated Case Management program 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 the overall health status of members.

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.
Supervise day to day activities to make certain that case management services are provided in accordance with clinical guidelines, established processes and MetroPlus organizational standards.
Supervise the entire care management workflow including case referrals, assignments, interventions and 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 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 performance.
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 with 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 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 Director of Complex Care Management.
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.
Employ critical thinking and judgment when dealing with unplanned issues.
Develop and maintain collaborative relationships with clinical providers, facility staff and community resources.
Ensure staff 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 Director of Complex Care & Social Determinants of Health.

Minimum Qualifications

Bachelor's degree required. Master's degree 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 health care setting required.
Minimum of 2 years direct patient experience in obstetrical care
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.
Ability to prioritize and manage changing priorities under pressure.
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, if needed.
Ability to work closely with member and caregiver.
Ability to form effective working relationships with a wide range of individuals.
Proficient in Microsoft Office applications including Word, Excel, and PowerPoint and Outlook.
Registered Nurse with a current New York State License

Professional Competencies