Senior Manager Clinical Eligibility

Healthfirst; Layton (UT); On-site; USD 105,100 - 160,480; Full time

Benefits offered by this job

Medical, dental, and vision coverage

401(k) contributions

Life insurance

Job summary

Healthfirst is seeking a Senior Manager of Clinical Eligibility in Layton, Utah. This leadership role involves directing the Assessment team and ensuring the successful implementation of clinical eligibility processes for Medicaid and Medicare programs. The successful candidate will manage staff development, coordinate compliance activities, and enhance member health management through effective support systems.

The ideal candidate must hold a NYS RN license and have strong communication, leadership, and interpersonal skills, coupled with substantial experience in managed care environments.

Qualifications

• Ability to handle rapidly changing crisis situations while achieving department goals.
• Proficient navigating internet browsers, computer hardware, and multiple applications simultaneously.
• Experience in a home-care environment or managed-long-term care settings.

Responsibilities

• Participates in all aspects of personnel management, including staffing and performance evaluations.
• Manages Assessment Managers to ensure timely assessments.
• Coordinates with contract services and facilitates problem-solving with care teams.

Skills

Interpersonal skills when interacting with frail adult populations

Leadership skills

Communication skills

Critical-thinking skills

Time-management skills

Problem-solving skills

Education

NYS licensed RN

Tools

Microsoft Office Suite

Project management tools

VPN and Citrix platform

Job description

The Senior Manager of Clinical Eligibility will have knowledge of the current assessment process for both Medicaid and Medicare programs. This position supports the Assessment Managers in planning, directing, and implementing processes to achieve successful outcomes and goals. The Senior Manager conducts and contributes to member and family education regarding health management and community resources to enhance population health. The role is responsible for the overall administration, development, and operation of the Assessment team.

Duties & Responsibilities

• Participates in all aspects of personnel management to ensure appropriate staffing, orientation, support, discipline, and timely performance appraisals.
• Meets regularly with direct reports to review goals, trends, and performance measures and to facilitate change.
• Participates in continued staff development to improve the decision‑making process.
• Provides administrative on‑call coverage to troubleshoot and coordinate the delivery of care and services to members.
• Manages Assessment Managers to ensure timely assessments and targeted interventions to meet a member’s changing condition(s).
• Supports the care‑management teams to ensure effective care management and oversight of home vendor services.
• Supervises and directs the completion of assessments at established intervals to coincide with care‑plan development/revision and ensures early identification and action to address emergent issues.
• Assists members and prospective members with assessment and clinical eligibility questions.
• Coordinates with contract services to ensure understanding of the MLTC model, FIDA, MAP, and MMCP and cooperation with the assessment process.
• Ensures coordination with home health, nursing, and social work care as it relates to the care plan.
• Facilitates problem solving by coordinating case conferences and investigations with the care teams.
• The Senior Manager of Clinical Eligibility functions as a facilitator for the team and managers to ensure smooth workflow, efficiency and success within the four programs: PHSP, CC, AE, and SHP.
• Functions as a liaison to ensure process coordination with different organizational departments such as Intake, Medical Records, CMT, IT, HR, and Marketing.
• Performs additional duties as assigned.

Minimum Qualifications

• NYS licensed RN.
• Strong interpersonal skills when interacting with frail adult populations, their families, and community care providers.
• Ability to handle rapidly changing crisis situations while still achieving department goals and objectives.
• Understanding of and sensitivity to cultural differences and needs of the community in a diverse and multi‑cultural work environment.
• Proficiency in Microsoft Office (Word, Excel, Outlook, PowerPoint, Access, Adobe, Visio) and project management tools.
• Proficient navigating internet browsers, computer hardware, and multiple applications simultaneously, using encryption security tools, multiple electronic PHI databases, working with a VPN and Citrix platform and very accurate typing skills.
• Demonstrated professionalism and leadership skills with the ability to develop, direct, and support staff.
• Experience in a home‑care environment; acute, sub‑acute or long‑term care (LTC) setting; or managed‑long‑term care (MLTCP).
• Experience in one of the following areas: managed‑care organization, PACE, MLTCP, CHHA, licensed agency, or a Lombardi program.
• Excellent communication, time‑management, writing, critical‑thinking and problem‑solving skills.
• Supervisory, training, or management experience.

Preferred Qualifications

• Knowledgeable of state and federal regulations, including experience interpreting those regulations as they pertain to different programs.
• Understanding of cultural diversity with language preferences in Spanish, Russian, French, Creole, Mandarin, Cantonese, and ability to work with members who speak these languages.

Regulatory or Compliance Activities

• Oversee compliance with SHP standards and time frames for care planning and other recurring activities in accordance with established guidelines and DoH regulations.
• Collaborate with the Department of Clinical Excellence (DOCE), coordinate orientation and in‑service programs to meet regulatory requirements and support performance improvement.
• Ensure compliance with time frames for care planning and other recurring activities in accordance with established guidelines and DOH regulations.

License or Certification

NYS RN license required.

Equal Opportunity Employer

HF Management Services, LLC is an equal opportunity employer. The company complies with all applicable laws and regulations. Applicants and employees are considered for positions without regard to race, color, creed, religion, sex, national origin, sexual orientation, pregnancy, age, disability, genetic information, domestic violence victim status, gender and/or gender identity or expression, military status, veteran status, citizenship or immigration status, height and weight, familial status, marital status, or unemployment status. HF Management Services, LLC shall not discriminate against any disabled employee or applicant in regard to any position for which the employee or applicant is otherwise qualified.

Accommodations for Applicants with Disabilities

If you have a disability under the Americans with Disabilities Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by email at [e-mail] or by calling 212-519-1798. In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within HF Management Services, LLC will be reviewed at the e‑mail address and phone number supplied.

Salary Range

Greater New York City Area (NY, NJ, CT residents): $122,900 - $188,020
All Other Locations (within approved locations): $105,100 - $160,480

Benefits

Healthfirst offers employees a full range of benefits including medical, dental, and vision coverage, incentive and recognition programs, life insurance, and 401(k) contributions. All benefits are subject to eligibility requirements.