Um Care Management Associate Supervisor

MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlusHealth network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlus has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.

Position Overview

Under the supervision of the Manager of Utilization Management (UM), the UM Care Management Associate (CMA) Supervisor is responsible for the supervision of the Care Management Associates within the UM department’s Personal Care Services (PCS) team. The CMA Supervisor monitors the CMA departmental ACD phone queue to ensure quality of calls between the Care Management Associates, members, and providers. The Supervisor conducts new hire training and continued training for all CMA PCS staff. The UM CMA Supervisor will enhance communication and processes for the non-clinical and clinical areas within PCS and between other internal operating departments.

• Provides guidance to the CMA support staff, particularly as it pertains to new processes and workflows implemented within the team
• Handles escalated calls by members and providers, requiring intervention
• Ensures the mailing of determination letters in accordance with mandated time constraints as applicable
• Manage, analyzes, and coordinates the daily activities of the unit to ensure department productive goals are met with regards to quality, timeliness, and accuracy.
• Manages, directs, and develops staff by providing feedback and coaching.
• Administers performance reviews for staff.
• Ensures staff meet all regulatory requirements and comprehend and comply with best practices methodology, professional standards, and internal policies and procedures
• Promotes and facilitates a multidisciplinary approach, supporting PCS coordinated care operations amongst disciplines.
• Oversee clinical program training/retraining and creation and updating of departmental training tools and resources.
• Act as a subject matter and training expert for Care Management processes and protocol in the systems utilized by UM PCS team and all other programs which support UM PCS operations.
• Maintains a tracking tool which logs unacceptable inconsistencies and errors observed during quality reviews of recorded calls via the queue and Care Management documentation, care planning, follow up and interventions.
• Prepares Fair Hearing packet for regulatory compliance team upon request.
• Provides guidance to the CMAs within the UM Department, particularly as it pertains to new processes and workflows which support program operations.
• Works collaboratively with UM management team to ensure program goals, projects, and initiatives are implemented and meet departmental workflows and policy standards.
• Creates and champions an atmosphere within the team which fosters open communication, teamwork, ownership, and a collaborative cross-departmental environment to implement, optimize, and share continuous improvement processes.
• Participates in staff meetings to offer ideas towards the enhancement of departmental processes
• Provides oversight of the authorization queues for PCS, to ensure regulatory compliance in meeting organizational determination timeframes
• Conducts oversight and monitoring of the department phone queue and queue activity reporting
• Investigates and solves claims related issues as appropriate per reporting and interdisciplinary departments
• Develops report(s) for tracking outstanding assessments needed for meeting regulatory timeframes
• Assigns and delegates daily assignments to the UM PCS CMA team for coverage purposes and business needs
• All other duties or actions as required under the direction of the UM management team

• High School Degree or equivalent required; Associate’s Degree preferred
• 1-3 years of supervisory experience required
• Managed Care background required in Personal Care Services or Consumer Directed Assistance Services.
• Understanding of medical terminology
• Excellent typing and computer literacy (Microsoft Word, Excel, etc.)

• Integrity and trust
• Customer service focus
• Functional/Technical skills
• Good communication and interpersonal skills.
• Good customer service skills.
• Excellent organizational and management skills.
• Able to handle large volume of work.
• Basic working knowledge of computer systems
• Dependable, reliable, and demonstrated good judgment ability.