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.

Director, Care Management Operations

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Director and Equivalent
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190TH Requisition #
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Assist in leading the strategic development of analytics and business intelligence to support population health and market growth initiatives.  Responsible for the day to day operation and performance, in collaboration with AVP Care Management, of the care management teams providing care management services both telephonically and field based.  Will spend time in the field as needed to support and provide oversight to the managers and staff in the field.  Responsible for the oversight and direct management of the general care management staff that operationalizes the requirements.  Provide education, coaching, and mentoring to team members to address performance related issues. Uses problem solving abilities to create solutions to operational and clinical issues identified during day to day operations.  Collaborate with the AVP of Care management to operationalize CM strategic plan.  Serve as an essential link between the Plan’s staff and its internal and external customers to promote and improve communication of initiatives relative to Care Management.  Address audit related findings and implement performance improvement strategies.  Collaborate with other functional areas within organization to ensure that care managers are implementing EmblemHealth Health Plans policies, procedures and all regulatory mandates, consistent with Emblem Health Plans mission, vision, purpose and value statement.  Responsible for data collection needed to report on program metrics. Over site of HEDIS/STARS and NCQA requirement responsibilities of the Care Management team to support Organizational deliverables.

Responsibilities:
  • Manage daily operations of the Care Management team (Managers and Care management team) including measurement of performance metrics and productivity standards and deploys strategies that will improve performance.  
  • Training employees in process operations and acting as a preceptor to newly hired staff. Completes quarterly evaluations of staff as needed.
  • Monitor team caseloads and shifts workloads accordingly to meet departmental/organizational needs.
  • Monitor timeliness and appropriateness of documentation in clinical systems to ensure that documentation meets accreditation and regulatory standards.  
  • Ensure that team members are managing enrollees across the care continuum  inclusive of behavioral health to ensure that enrollees have access to needed care and services.
  • Serve as a clinical resource and attends Care Management rounds. 
  • Monitor employees’ performance regularly and coaches employees as needed.
Qualifications:
  • Bachelor’s degree in Nursing or other degree 
  • RN required, current New York State RN license required
  • CCM certified required, but consideration will be given for current enrollees
  • 10 -12 years of related professional experience required
  • 5+ years of staff and/or process experience in a healthcare provider environment required
  • 3 – 5 years of statistical/analytical experience required
  • Additional years of specialized experience, skills, certifications, or training may be considered in lieu of educational requirements; required
  • Familiar with Population Health Management preferred
  • Experience leading care management teams preferred
  • Ability to identify problems, develop/recommend solutions, and execute implementations to resolve issues; and to collaborate with both departmental and other management/leadership to improve performance required
  • Detailed oriented and organized, with excellent time management and prioritization skills required
  • Excellent written and oral communications skills required
  • Proficiency with Microsoft Office suite of applications (Word, Excel, Powerpoint) 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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