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.

Manager, Care Management

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Manager & Professional
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210JD Requisition #
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Summary of Job:

Responsible for the day to day operation and performance of the care management team providing care management services to EmblemHealth members. Provide services in order to monitor team member performance which includes quality, outcome and productivity measures and deploys strategies to improve performance. Provides 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.  Collaborates with the Director and AVP of Care Management and internal audit teams to address audit related findings and implement performance improvement strategies. 
Collaborates 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.

Requirements:

  • Manage daily operations of the 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
  • Monitors timeliness and appropriateness of documentation in clinical systems to ensure that documentation meets accreditation and regulatory standards
  • Ensures 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
  • Serves as a clinical resource and attends Care Management rounds. 
  • Monitors employees’ performance regularly and coach employees as needed
     

Qualifications:

  • Bachelor’s degree in Nursing or other degree
  • RN required, current New York State RN license required
  • Additional experience could be considered in lieu of education requirements
  • CCM certified required, but consideration will be given for current enrollees
  • 5 years of clinical experience  
  • Health plan experience highly desirable  
  • Experience leading care management teams required  
  • Strong problem-solving skills
  • Detailed oriented and organized 
  • Excellent written and oral communications skills
  • Strong working knowledge of Microsoft products including Excel and PPT 
  • Strong problem solving and strategy execution abilities.  Able to analyze problems and deploy strategies to improve performance in collaboration with the leadership team
     

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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