Company Statement

For the last 80 years, EmblemHealth has been taking care of New York’s heart and soul, its people. Today, health care is more complex than ever. That’s why we’re at the forefront of change. We work alongside our customers to offer access to high-quality, affordable care, help navigate the health care experience, and make good health achievable; because everyone deserves to be taken care of. We deliver on our mission every day by living our values with our colleagues, members, clients and partners. It begins with caring and respecting all those we work with. We believe a culture of diversity and inclusion is vital to serve our unique and diverse customers. We seek for continues improvement and innovation and believe being agile and nimble is our advantage. We bring a strong sense of partnership to every relationship – internally and externally. The EmblemHealth family of companies offers competitive health, welfare, and retirement benefits as well as incentive pay plans and more.

Care Management Manager, Healthy Beginnings

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Manager & Professional
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1912Q Requisition #
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Responsible for the day to day operation and performance of the Healthy Beginnings care management team.  Works in collaboration with the Clinical Director to manage operations functions and tasks of the Healthy Beginnings Program.  Review annual assigned Operational Procedures (OP).  Oversee the clerical operations and data collection for the individual programs and Accreditation responsibilities within the Care Management Program such as TIP, HRA and NCQA.  Collaborate with the Care Management Managers to address audit-related findings and implement performance improvement strategies.  Lead the Healthy Beginnings programs in conjunction with other functional areas within the department to ensure that the care management team is implementing EmblemHealth Health Plans policies, procedures and all regulatory mandates, consistent with Emblem Health Plans mission, vision, purpose and value statement.  Outreach to members as needed and an on ongoing basis.

Responsibilities:
  • Manage the care management Healthy Beginnings staff and associated activities in compliance with regulatory and accredited requirements.
  • Develop all Regulatory Policy/Workflow, which includes Training and Implementation.
  • Utilize problem solving abilities to create solutions to issues identified during day to day operations.  
  • Work with Healthy Beginnings stakeholders and conduct meetings to define roles, responsibilities and review requirements/expectations for all regulatory projects.
  • Serve as the subject matter expert and point of communication for all issues related to the Pregnancy and Healthy Beginnings program. 
  • Perform member outreach and surveys through the program’s telehealth platform and telephonically.
  • Monitor individual work assignments for timeliness and appropriateness of documentation in on-line data systems, and where appropriate, to ensure that documentation meets regulatory and accredited standards.
  • In collaboration with other Care Management managers and staff, monitor employees’ performance, key performance indicators, audits, case reviews, etc.  
  • Mentor and coach team members to address performance issues. 
  • Perform corrective action and/or counseling as needed.
  • Train employees in process operations and act as a preceptor to newly hired staff.  
  • Complete staff evaluations as needed; perform other duties as assigned.
Qualifications:
  • Bachelor’s degree in Healthcare or related field
  • 5 – 8 years or relevant, professional work experience required
  • Additional years of experience or specialized training may be considered in lieu of educational requirements required
  • Demonstrated skill in managing workflows, processes, and staff, preferably in a healthcare provider environment required
  • Ability to effectively train and motivate staff; and to manage performance required
  • Strong problem-solving ability; experience in producing consistently excellent results required
  • Excellent written and verbal communication skills with all types and levels of audiences required
  • Proficiency with MS Office suite of applications (word processing, database/spreadsheet, presentation) required
  • Supervisory experience or specialized training required

EEOC Statement

We are committed to leveraging the diverse backgrounds, perspectives and experiences of our workforce to create opportunities for our people and our business. We are an equal opportunity/affirmative action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or any other characteristic protected by law.

Sponsorship Statement

Depending on factors such as business unit requirements, the nature of the position, cost and applicable laws and regulations, EmblemHealth may provide work visa sponsorship for certain positions.

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