Senior Manager Clinical Eligibility

The Senior Mgr of Clinical Eligibility will have knowledge of the current assessment process, for both Medicaid and Medicare programs. This position will support the Assessment Managers in planning, directing, and implementing processes for successful outcomes and achieving goals. The Sr Mgr conducts and contributes to member and family education regarding health management and community resources to enhance population health. This position will be responsible for the overall administration, development, and operation of the Assessment team.

Duties & Responsibilities:  

• Participates in all aspects of personnel management to ensure appropriate staffing, orientation, support, discipline, and timely performance appraisals.
• Meets regularly with direct reports to review goals, trends, and performance measures and to facilitate change.
• Participates in continued staff development to improve the decision-making process. 
• Provides administrative on-call coverage to troubleshoot and coordinate the delivery of care and services to members.  
• Manages Assessment Managers to ensure timely assessments and targeted interventions to meet a member’s changing condition(s).
• Supports the care management teams to ensure effective care management and oversight of home vendor services.
• Supervises and directs the completion of assessments at established intervals to coincide with care plan development/revision and ensures early identification and action to address emergent issues.
• Assists members and prospective members with assessment and clinical eligibility questions.
• Coordinates with contract services to ensure understanding of the MLTC model, FIDA, MAP, and MMCP and cooperation with the assessment process.
• Ensures coordination with home health, nursing, and social work care as it relates to the care plan.
• Facilitates problem solving by coordinating case conferences and investigations with the care teams. The Sr Mgr of Clinical Eligibility will function as a facilitator for the team and managers to ensure smooth workflow, efficiency and success within the four programs: PHSP, CC, AE, and SHP.
• Functions as a liaison to ensure process coordination with different organizational departments such as Intake/Medical Records/CMT/IT/HR/Marketing.
• Additional duties as assigned.

Minimum Qualifications:   

• NYS licensed RN

  Preferred Qualifications:    

• Knowledgeable of state and federal regulations including experience interpreting those regulations as it pertains to different programs.
• Excellent interpersonal skills, especially relating well with a frail adult population, their families and community care providers, along with demonstrated ability to handle rapidly changing crisis situations while still achieving department goals and objectives.
• Understanding of and sensitivity to cultural differences and needs of the community are essential with a diverse and multi-cultural work environment and community of members such as Spanish, Chinese, Russian, Creole and Korean.
• Language preferences - Spanish, Russian, French, Creole, Mandarin, Cantonese
• Bachelor’s degree
• Intermediate Microsoft Word, Excel, Outlook, Powerpoint, Access, Adobe, Visio, and project skills 
• Proficient navigating internet browsers, computer hardware, and multiple applications simultaneously, using encryption security tools, multiple electronic PHI databases, working in with a VPN and Citrix platform and very accurate typing skills.
• Demonstrated professionalism and leadership skills along with the ability to develop, direct, and support staff
• Experience in home care environment, acute, sub-acute or long term care (LTC) setting or managed-long term care (MLTCP). 
• Experience in one of these areas: managed care organization, PACE, MLTCP, CHHA, licensed agency or a Lombardi program. 
• Excellent communication, time management, writing, critical thinking, and problem solving skills.
• Supervisory, training, or management experience.

  Regulatory or Compliance activities:

• Overseeing compliance with SHP standards and time frames for care planning and other recurring activities in accordance with established guidelines and DOH regulations.
• Collaborating with the Department of Clinical Excellence (DOCE), coordinate orientation and in-service programs to meet regulatory requirements and support performance improvement.

  License or Certification: NYS RN license

WE ARE AN EQUAL OPPORTUNITY EMPLOYER.  HF Management Services, LLC complies with all applicable laws and regulations. Applicants and employees are considered for positions and are evaluated without regard to race, color, creed, religion, sex, national origin, sexual orientation, pregnancy, age, disability, genetic information, domestic violence victim status, gender and/or gender identity or expression, military status, veteran status, citizenship or immigration status, height and weight, familial status, marital status, or unemployment status, as well as any other legally protected basis. HF Management Services, LLC shall not discriminate against any disabled employee or applicant in regard to any position for which the employee or applicant is otherwise qualified.

If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to [email protected] or calling 212-519-1798 . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within HF Management Services, LLC will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with HF Management Services,  LLC.

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All hiring and recruitment at Healthfirst is transacted with a valid “@healthfirst.org” email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst.  Healthfirst will never ask you for money during the recruitment or onboarding process.

Hiring Range*:

• Greater New York City Area (NY, NJ, CT residents): $122,900 - $188,020

• All Other Locations (within approved locations): $105,100 - $160,480

As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.

In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.

*The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role.