MetroPlus Health Plan 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, MetroPlus’ network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlus has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.
The Director for Children’s Special Services (DCS) manages the operational, regulatory, clinical and oversight activities of the Children Special Services program. The DCS is responsible for high touch coordination between MetroPlus, Beacon Health Options, Health Homes, OCFS, and LDSS/VFCA. The DCS works with the Plan’s Medical Director for Medically Fragile Children to ensure that members receive all medically necessary care, proper health home coordination services, timely CANS-NY assessments, and appropriate HCBS services.
- Responsible for the overall operation of MetroPlus’ Children’s Special Services Unit.
- Responsible for oversight of the Physical Health Utilization Management, Care Management and Health Home Liaison functions
- Works with Children’s Special Services and Beacon Health Option’s clinical staff to ensure the provision of Behavioral Health services, Health Home coordination and needed HCBS services to members.
- Works with the Children’s Special Services Quality Specialist and MetroPlus and Beacon’s quality departments on quality improvement projects, Performance Improvement Plans and relevant HEDIS and QARR activities.
- Responsible for timely and accurate reporting to the Children’s Advisory Committee, MetroPlus’ UM Subcommittee and MetroPlus BH Core Subcommittee.
- Ensures that the Children’s Special Services clinical team comply with UM requirements for the medically fragile population set forth by the “Office of Health Insurance Programs Principles for Medically Fragile Children”.
- Provides oversight of all Beacon’s children’s special services activities.
- Works with MetroPlus’s customer service to ensure the proper enrollment/disenrollment of children in Foster Care.
- Ensures the full integration of Medical (MetroPlus’ Children’s Special Services staff) and BH activities (Beacon’s staff).
- Oversees Health Home assessment and assignment activities.
- Sets program goals and implements continuous improvement activities to achieve them.
- Ensures the monitoring of care coordination, CANS-NY assessments and HCBS services provided by Health Homes and HCBS providers.
- Works with MIS, Core Configuration, Claims, Provider Contracting and otherinternal departments both within MetroPlus and Beacon to ensure smooth operations of the unit.
- Perform other duties as assigned by Medical Director, and the Behavioral Health Associate Executive Director.
- Masters Degree in Social Services, higher degreepreferred
- Must have a minimum of 10 years working in health care management company.
- Must have at least 7 years of experience in a management position.
- Must have thorough knowledge of the Medicaid Managed Care Organization Children’s System Transformation Requirements and Standards.
- Experience working with Health Homes.
- Knowledge of QM and UM activities and reporting.
- Clinical experience, a plus.
- An equivalent combination of education, training and experience, knowledge and skills sufficient to indicate ability to perform satisfactorily
- Integrity and Trust
- Management and leadership skills
- Ability to work on few tasks at the same time under strict time table
- Excellent written/oral communication skills
- Ability to collaborate with different stake holders.
- Functional Skills
- Excellent organizational skills