Position Summary:This position oversees the nursing staff on Integrated Care Teams (ICT), supporting care coordination for members living with HIV, transgender and gender-diverse members (GIST), high-risk members, and pediatric/head of household populations. The Manager also oversees Transition of Care (TOC) and Long-Term Services (LTS)/Skilled Nursing Facility coordination, providing clinical, operational, and administrative leadership to ensure members' complex medical, behavioral, pharmaceutical, and psychosocial needs are met. This role also reviews clinical cases requiring supervisory approval and provides coverage for Care Coordinators as needed.
Responsibilities:- Provide clinical, operational, and administrative oversight of the Integrated Care Team (ICT), Transition of Care (TOC), and Long-Term Services (LTS) programs, ensuring effective implementation of the Model of Care and delivery of high-quality, coordinated member care.
- Supervise, coach, and evaluate Care Coordination staff, including High-Risk, GIST, PedsHoH, Senior Care Coordinators, and Care Coordinators, while monitoring productivity, documentation, quality outcomes, and compliance with regulatory and accreditation standards.
- Maintain a limited caseload and provide clinical oversight of complex case management by conducting case reviews, utilizing clinical judgment, and providing coverage during staffing shortages or high-volume periods.
- Collaborate with providers, community partners, and internal departments to coordinate care, educate members and providers on Plan benefits and clinical programs, resolve escalated issues, and improve member outcomes.
- Oversee Long-Term Care (LTC), Skilled Nursing Facility (SNF), Transition of Care, Behavioral Health, HCBS, discharge planning, inpatient census review, and post-discharge follow-up activities across the continuum of care.
- Lead quality improvement initiatives by establishing performance metrics and dashboards, conducting comprehensive assessments, monitoring quality indicators, identifying gaps in care, and implementing process improvements to enhance clinical outcomes and regulatory compliance.
- Support departmental operations through staff recruitment, onboarding, training, performance management, policy implementation, special projects, grievance resolution, and development of clinical education materials.
- Ensure timely completion and oversight of required documentation, regulatory reporting, HIV verification, ICT reports, member grievances, HIPAA compliance, and other assigned clinical and operational responsibilities.
EDUCATION REQUIRED- NYS Licensed Registered Nurse
EXPERIENCES AND/OR SKILLS REQUIRED- At least five (5) years' direct patient care and/or managed care experience.
- Two (2) years of experience with HIV/AIDS or chronic conditions preferred.
- Three (3+) years of Medicaid Managed Care Organization working experience preferred.
- Healthcare and staff leadership experience preferred.
- Demonstrated leadership skills. Prior experience as a clinical supervisor is strongly preferred.
- Strong knowledge of Microsoft Office (Access, Word and Excel).
- Demonstrate understanding and sensitivity to multi-cultural values, beliefs, and attitudes of both internal and external contacts.
- Demonstrate appropriate behaviors in accordance with the organization's vision, mission, and values.
