Clinical UM Team Lead – Care Management & Coordination

MetroPlusHealth; New York (NY); On-site; USD 90,000 - 120,000; Full time

Job summary

MetroPlusHealth in New York City seeks a Clinical Team Lead to manage both simple and complex medical cases, coordinating outpatient and inpatient services to ensure high-quality care and cost efficiency.

Under the direction of the VP of Clinical Services, you will assist in directing care to the most appropriate setting and assess outcomes through outreach to members. Requires 2–5 years of clinical experience and active NYS licensure where applicable.

Qualifications

• High School Diploma or GED required; RN/LPN/PT licensure preferred as applicable.
• 2–5 years of clinical experience in an acute or applicable care setting.
• UM/UR experience in managed care or hospital setting required

Responsibilities

• Manages simple and complex medical cases to achieve high-quality patient care outcomes.
• Coordinates services across outpatient and inpatient settings to minimize unnecessary costs.
• Directs care to appropriate settings and evaluates outcomes through outreach to members.
• Performs utilization management activities in compliance with regulatory requirements.
• Contributes to medical management rounds and collaborates with Physician Advisor/Medical Director.

Skills

Integrity and Trust

Customer Focus

Communication skills

Computer skills

Education

High School Diploma/GED

Job description

MetroPlusHealth in New York City seeks a Clinical Team Lead to manage both simple and complex medical cases, coordinating outpatient and inpatient services to ensure high-quality care and cost efficiency.

Under the direction of the VP of Clinical Services, you will assist in directing care to the most appropriate setting and assess outcomes through outreach to members. Requires 2–5 years of clinical experience and active NYS licensure where applicable.