RN Care Management Lead — Complex Care & Outcomes

EmblemHealth; New York (NY); In loco; USD 7800 - 149.000; Tempo pieno

Vantaggi offerti da questo lavoro

Competitive benefits

Descrizione del lavoro

EmblemHealth in New York seeks a clinical leader to oversee Care Management and Community Health Workers serving members with complex medical, behavioral health, and social needs. You will direct day-to-day care management, ensure timely documentation, and drive performance using quality and cost-of-care data.

Requirements include an NY RN license, 5–8+ years of clinical care management leadership, and strong communication. CCM preferred; MS Office proficiency required.

Competenze

• Bachelor's degree required, preferably in Nursing.
• Current New York State RN license required.
• CCM certification preferred.
• 5 - 8+ years of clinical experience (Required).
• Health plan experience (Preferred).
• Experience leading care management teams (Required).
• Detail oriented; strong analytical and problem-solving skills; ability to execute on strategy (Required).
• Proficient with MS Office (Word, Excel, PowerPoint, Outlook, Teams, etc.) (Required).
• Able to analyze problems and recommend and deploy strategies to improve performance with leadership (Required).

Mansioni

• Manage daily operations of the Care Management team including measurement of performance metrics and productivity standards.
• Provide regular case consultation, clinical supervision, and mentoring to team members to ensure clinical rigor, productivity, and address performance-related issues.
• Monitor timeliness and appropriateness of documentation in clinical systems to ensure that documentation meets accreditation and regulatory standards.
• Ensure that team members are managing enrollees across the care continuum, inclusive of behavioral health, so that enrollees have access to needed care and services.
• Provide clinical oversight and direction to Care Managers and Community Health Workers supporting members with complex medical, behavioral health, and social needs.
• Ensure delivery of evidence-based, member-centered care management interventions.
• Support appropriate stratification and management of high-risk, high-cost populations.
• Monitor clinical decision-making for consistency with health plan policies, regulatory requirements, and professional standards.
• Ensure timely completion of assessments, care plans, outreach activities, and documentation.
• Utilize data to monitor team member and program performance, including quality, outcomes, productivity, and service levels, and deploy strategies to improve program efficiency and effectiveness.
• Identify operational barriers and implement process improvements.
• Collaborate with utilization management, behavioral health, pharmacy, quality, and provider teams.
• Train employees in process operations; act as a preceptor to newly hired staff.
• Monitor employees' performance regularly and coach employees as needed.
• Ensure compliance with NCQA, CMS, state, accreditation, and organizational standards.
• Participate in audits, quality reviews, and corrective action plans.
• Monitor adherence to care management programs, policies, and documentation requirements.
• Support quality improvement initiatives focused on clinical outcomes, member experience, and cost of care.
• Serve as a clinical resource; attend Care Management rounds.
• Perform other related tasks as directed or required.

Conoscenze

Leadership

Clinical supervision

Analytical thinking

Communication skills

MS Office

Task organization

Formazione

Bachelor's degree (preferably Nursing)

Strumenti

MS Office

Clinical documentation systems

Descrizione del lavoro

EmblemHealth in New York seeks a clinical leader to oversee Care Management and Community Health Workers serving members with complex medical, behavioral health, and social needs. You will direct day-to-day care management, ensure timely documentation, and drive performance using quality and cost-of-care data.

Requirements include an NY RN license, 5–8+ years of clinical care management leadership, and strong communication. CCM preferred; MS Office proficiency required.