Medicare Integrated Care Director

MetroPlus; New York, Northern (NY, KY); Hybrid; USD 150,000 - 210,000; Full time

Job summary

MetroPlusHealth in New York City seeks a Director of Integrated Care Management (Medicare) to lead the Medicare Advantage and IB-Dual lines, ensuring care quality and CMS compliance. This role oversees clinical and non-clinical staff and drives care coordination across medical, behavioral, and social needs to keep members safely in the community.

The ideal candidate holds a BSN with a Master’s preferred, 10+ years in healthcare management, and 5+ years in senior leadership, with strong

Qualifications

• Must have BSN; MSN preferred.
• 10+ years in healthcare management.
• 5+ years in a senior leadership role (manager level and above).
• Familiar with OMH, DOH, CMS regulations in managed care.

Responsibilities

• Develops and guides vision/strategies for Integrated Care Management; collaborates on strategy implementation.
• Oversees staff and functions of the Integrated Care Management Department and Medicare line of business.
• Ensures care management aligns with risk stratification and care processes.
• Participates in development/review of quality improvement plans.

Skills

Nursing leadership

Healthcare management

Regulatory compliance

Data-driven decision making

Communication skills

Education

Bachelor of Science in Nursing

Master’s Degree in Nursing

Job description

MetroPlusHealth in New York City seeks a Director of Integrated Care Management (Medicare) to lead the Medicare Advantage and IB-Dual lines, ensuring care quality and CMS compliance. This role oversees clinical and non-clinical staff and drives care coordination across medical, behavioral, and social needs to keep members safely in the community.

The ideal candidate holds a BSN with a Master’s preferred, 10+ years in healthcare management, and 5+ years in senior leadership, with strong