Company Statement
EmblemHealth is one of the nation’s largest not for profit health insurers, serving members across New York’s diverse communities with a full range of commercial and government-sponsored health plans for employers, individuals, and families. With a commitment to value-based care, EmblemHealth partners with top hospitals and doctors, including its own AdvantageCare Physicians, to deliver quality, affordable, convenient care. At over a dozen EmblemHealth Neighborhood Care locations, members and non-members alike have access to community-based health and wellness guidance and resources. For more information, visit emblemhealth.com.
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Lead, Total Population Health - Multiple Openings/REMOTE
🔍 New York, New York
Summary of Position
Support the integration of care and utilization management to Total Population Health holistic model of care, characterized by multi-disciplinary and provider collaboration alignment, innovative clinical programs and practices to achieve the four primary goals (enhance patient experience, improve population health, reduce costs, and improve the work life of health care providers, including clinicians and staff) through care and disease management processes. Responsible for the execution of efficient departmental processes designed to manage inpatient and outpatient utilization and quality of care within the benefit plan. Contribute to the overall success of Total Population Health by promoting /advancing the department mission of effectively facilitating care and improving outcomes at all points along the health care continuum, from preventive health and wellness through chronic care management to end of life care in all health care settings. Actively collaborates with other Total Population Health Supervisors and delegates/vendors to promote integration of processes and workflows across teams and eliminate duplication. Maintain an environment of quality improvement through continuous evaluation of processes and policies. Identifies and recommends new technologies and process efficiencies. Provide services per the NYCE contract.
Principal Accountabilities
- Act as a coach and mentor to staff to ensure understanding of utilization, disease and complex care management concepts and effectively apply the concepts to managing members’ health care needs; and to serve as coach and mentor to staff to ensure compliance with company, State, Federal and NCQA requirements related to utilization and care management activities; supervise, train, evaluate and develop assigned staff.
- Develop, monitor, and communicate performance expectations and plan for all direct reports and conduct performance reviews within specified timeframe; provide feedback on a regular basis.
- Assist with resolution of employee performance issues.
- Complete monthly telephone audits of staff using technology and provide feedback to staff.
- Track audit results toward performance objectives.
- Track and report statistics on care management and/or utilization management activities, process measures (e.g. timeliness), quality results, and other measures that affect departmental objectives.
- Facilitate staff’s engagement with provider collaboration arrangements, and other physician organizations in the management of their attributed members.
- Maintain an environment of quality improvement through continuous evaluation of processes and policies. Identifies and recommends new technologies and process efficiencies.
- Interact with various departments throughout the enterprise and contribute to the resolution of interdepartmental issues. Lead and develop team to quickly assess and diagnose root causes to problem areas.
- Actively participate on assigned committees and projects.
Perform duties of a care manager or utilization manager as needed; and other duties as assigned.
Qualifications
- Bachelor’s Degree in Nursing, health care, business, or related field
- RN, with active license
- 5 – 8 years of relevant, professional work experience
- 5+ years of clinical experience
- 2+ years of managed care experience; supervisory experience
- Additional years of experience/training may be considered in lieu of educational requirements
- State of the art knowledge of care management scope of practice
- Excellent communication skills (verbal, written, presentation, interpersonal)
- Proficiency with MS Office (Word, Excel, Access, PowerPoint, Outlook)
- Strong organizing, prioritizing, analytical, and problem-solving skills
- Ability to provide weekend and holiday coverage on a rotating basis
Security Disclosure
If you receive a job offer from EmblemHealth, the email will be from “HRTalentAcquisition” with the subject: “Offer of Employment for (job title) – Please respond online.” We will never ask you to join a Google Hangout, buy your own equipment, or pay to apply. We also do not use third-party email services like Yahoo or Gmail.
Pay Disclosure
At EmblemHealth, we prioritize transparency in our compensation practices. We provide a good faith estimate of the salary range for potential hires, which is based on key factors such as role responsibilities, candidate experience, education and training, internal equity, and market conditions. Please be aware that this estimate doesn’t account for geographic differences related to your work location. Typically, new hires may not start at the top of this range, as compensation is tailored to each individual's circumstances. For union positions, salaries will be determined according to the collective bargaining agreement. Join us at EmblemHealth, where your contributions are valued and supported by fair compensation.
EEOC Statement
We value the diverse backgrounds, perspectives, and experiences of our workforce. As an equal opportunity employer, we consider all qualified applicants for employment regardless of race, color, religion, sex, sexual orientation, gender identity, pregnancy, marital status, national origin, disability, veteran status, or any other protected characteristic protected by law.
Sponsorship Statement
At EmblemHealth, we are committed to building a diverse and talented workforce. However, we are unable to consider applicants who require, or are likely to require, either before or after hire, visa sponsorship for work authorization in the United States, including but not limited to H-1B, F-1 (STEM OPT), TN, or any other non-immigrant status. Some extremely rare exceptions may apply based on critical business needs.