Manager, Medical Management - Complete Care
Healthfirst - New York, NY

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The Manager – Complete Care assumes a leadership role within Complete Care and for Healthfirst's Medicare/Medicaid members and providers to insure high quality, cost-effective patient care and appropriate allocation of member services and resources.

This is a paperless work environment requiring daily hands-on administration of multiple proprietary and packaged electronic databases including security requirement tools such as encryption. These systems include, but are not limited to, Electronic Medical Records, Sunguard Macess Service Module for electronic archiving, e-fax, VoIP, Virtual Work Platforms (using VPN), and scanning.

Essential Duties and Responsibilities:
  • Oversees the provision of the basic Medical Management functions which include: pre-certification, concurrent review, discharge planning, case management, disease management and referrals.
  • Trains new staff and provides ongoing training as necessary. Maintains staff productivity, effectiveness and efficiency. Develops key indicators for staff; audits staff to achieve key indicators and optimal outcomes.
  • Develops and analyzes operational and analytical reports needed to monitor and track operational efficiency.
  • Ensures compliance with the stated goals of the Medical Management Department and the overall organization.
  • Conducts daily, weekly, monthly and quarterly meetings with staff to review process issues; attends case manager meetings to review and monitor ongoing cases.
  • Knowledge of UM/QM case philosophies and reporting requirements to State and Federal agencies. Knowledge of quality improvement methodologies. Ability to work in a fast-paced environment and enhance team productivity.
Qualifications Summary:
Required: Associate’s degree.

Required licenses, certificates, etc.

Required: RN Licensure.

Work Related Skills and Experience:
Minimum Qualifications:
Technical Skills :
Intermediate Microsoft Word, Excel and Outlook, Electronic Medical Records and Database Searches, Archiving/Scanning, PC knowledge working remotely through VPN connection.

  • Associate's degree in Nursing. Nursing Diploma and 10+ years of related nursing/case management experience will also be considered.
  • Minimum of 3 years managed care or clinical nursing experience, which includes supervision and training of staff, in a nursing home, visiting nurse agency, home-based care, HMO organization or hospital dealing with frail and/or populations who are 55 years of age and older.
Physical Demands:
While performing the duties of this job, this employee will be occasionally reaching, bending, overhead lifting, driving, and traveling. This employee will also be frequently walking and standing; and constantly sitting and keying.

Work Environment :
This employee will constantly be in an indoor environment.

Additional Information:
After training at our NYC Corporate Headquarters, position telecommutes from home approximately 4 days a week and works from 100 Church Street as needed. Position requires on-call availability a few weekends a year.

Telecommuter requirements:
  • Direct Ethernet FIOS or Cable internet connection (wireless connection not permitted).
  • Locked file cabinet for secure storage of equipment and paperwork such as job aides (Employee’s expense).
  • This is a paperless environment so there is no printing when working virtually and for the security of patient health information (PHI).
  • Separate designated home work area away from the main flow of home traffic.
  • No dependent care.
  • HF has the right to conduct home site inspection with 24 hours of notice.
  • Random work activity audit reports will be conducted for all telecommuting employees analyzing performance and system activity on a given day.
  • The employee will be supplied with laptop, head-set for VOIP phone system, blackberry and all necessary applications for business purposes only.
Healthfirst offers a comprehensive benefits package including, but not limited to:

  • Medical
  • Dental
  • Vision
  • Basic Life and Accident Insurance
  • Supplemental Life insurance
  • Dependent Life Insurance
  • Short-Term Disability
  • Buy-Up Short Term Disability
  • Long-Term Disability
  • Flexible Reimbursement Accounts
  • Healthfirst 401(k) Plan
  • Employee Assistance Plan
  • Commuter Savings Program
  • Eligibility for Annual Bonuses
  • Generous Paid Time Off program
  • Paid Candidate Referral Program
Conditions of Employment: Employee must pass pre-employment screening which includes a background check and drug testing. Employee must present documentation to verify minimum of high school educational requirement.

Disclaimer: The statements herein are intended to describe the general nature and level of work being performed by employees assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of personnel so classified.

All qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, national origin, disability or veteran status .