Administrative Manager Medical Management

2020 Montefiore Mount Vernon Hospital; United States; On-site; USD 100,000 - 125,000; Full time

Job summary

2020 Montefiore Mount Vernon Hospital is seeking a qualified candidate to manage the operations of Medical Management. The role requires overseeing departmental activities including discharge planning and high-risk case management while ensuring compliance with regulations.

The ideal candidate holds a Bachelor's degree in nursing and has at least five years of relevant experience. The position emphasizes collaboration, leadership, and strategic planning within health care services.

Qualifications

• Minimum of five years of job-related experience.
• Knowledge and/or experience in managed care.
• Ability to collaborate with multidisciplinary groups.

Responsibilities

• Manage department operations and activities.
• Develop program philosophy and operational goals.
• Ensure compliance with state and federal regulations.

Skills

Bachelor’s degree in nursing

Collaboration skills

Knowledge of community resources

Healthcare industry knowledge

Education

Bachelor’s degree in nursing

Master’s degree in nursing or health management

Job description

City/State: Mount Vernon, New York

Grant Funded: No

Department: MMV Medical Management

Work Shift: Day

Work Days: MON-FRI

Scheduled Hours: 8 AM-4:30 PM

Scheduled Daily Hours: 7.5 HOURS

Pay Range: $100,000.00-$125,000.00

Job Summary

Ensure that patients receive quality care in the most cost-effective manner and at the appropriate level. Manage the Department's operations and activities, including discharge planning, utilization management, transition of care, and high-risk case management. Provides strategic and operational leadership for care management services, including Case Management, Social Work, and Care Transitions. Ensures optimum utilization of Social Work and RN Case Management Skills. Collaborate across departments to align care coordination with organizational goals, especially Length of Stay (LOS) optimization and discharge efficiency. Responsible for achieving and promoting continuous quality improvement, optimal financial productivity, patient satisfaction, and other objectives identified by the Leadership Team. In collaboration with the Senior Director, this position is responsible for staff performance, establishing policies and procedures governing the program's operations, and achieving goals in accordance with all State and Federal Guidelines.

Responsibilities

• Provides direct management to Staff.
• Develops program philosophy and operational goals consistent with the Organization’s Mission and Strategic Plan.
• Ensures program compliance with Joint Commission, State, and Federal Regulations related to Discharge Planning, Utilization Management, Transition of Care, and Continuum of Care.
• Creates and fosters positive customer relationships with patients, interdisciplinary teams, healthcare agencies, and the Network.
• Supports effective Customer Service Networks in collaboration with the team.
• Identifies growth opportunities.
• Develops and implements new services and/or programs.
• Interfaces and coordinates services with Admission, Finance, Managed Care, Medical Records, Home Care, Rehabilitative, and Risk Management.
• Ensures provisions of a seamless continuum of care.
• Ensures consistency in workflows, documentation, and discharge planning practices.
• Support appropriate level of care decisions (e.g., admission, observation, home-based care).
• Team Leadership and Development: Collaborate with the Senior Director to lead, mentor, and develop a high‑performing care management team; promote professional development and succession planning across the care management structure; foster a collaborative, inclusive, and accountable culture.
• Establishes and coordinates communication with all Utilization Regulatory Agencies.
• Oversees appeals at the first level of appeal as appropriate to maximize reimbursement.
• Reviews and edits Managed Care Contract Language relating to Utilization Management Issues.
• Fulfills all compliance responsibilities related to the position.
• Ensures compliance with CMS, Joint Commission, and all relevant regulatory requirements.

Qualifications

• Bachelor’s degree in nursing and a minimum of five years of job-related experience.
• A master’s degree in nursing or health management is desired but not required. MSW considered.
• Knowledge of community resources, agencies, and financial assistance programs, knowledge and/or experience in managed care.
• Ability to collaborate with multidisciplinary groups and staff at all levels, including community partners.
• Must possess comprehensive knowledge of the healthcare industry, familiarity with government regulations, and possession of strategic planning skills.

Equal Employment Opportunity Statement

Montefiore Mount Vernon Hospital is an equal employment opportunity employer. Montefiore Mount Vernon Hospital will recruit, hire, train, transfer, promote, layoff and discharge associates in all job classifications without regard to their race, color, religion, creed, national origin, alienage or citizenship status, age, gender, actual or presumed disability, history of disability, sexual orientation, gender identity, gender expression, genetic predisposition or carrier status, pregnancy, military status, marital status, or partnership status, or any other characteristic protected by law.