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.
Manager, Care Management - LTSS/RN - Remote
Summary of Job
Responsible for the day-to-day operation and performance of the care management team providing care management services to EmblemHealth members. Utilize data to monitor team member performance (quality, outcome and productivity measures, etc.); deploy strategies to improve performance. Provide coaching and mentoring to team members to address performance related issues. Use problem solving abilities to create solutions to operational and clinical issues identified during day-to-day operations. Collaborate with the Director and AVP of Care Management and internal audit teams to address audit related findings and implement performance improvement strategies. Develop job aides, work flows and other tools to enhance delivery of care management services. Collaborate with other functional areas within organization to ensure that Care Managers are implementing EmblemHealth Health Plans policies, procedures and all regulatory mandates, consistent with Emblem Health Plans mission, vision, purpose
and value statement.
Responsibilities
- Manage daily operations of the Care Management team including measurement of performance metrics and productivity standards; implement, deploy, and reinforce strategies to improve performance.
- Train employees in process operations; act as a preceptor to newly hired staff.
- Complete quarterly evaluations of staff as needed.
- Monitor team caseloads; shift workloads accordingly to meet departmental/organizational needs.
- 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.
- Serve as a clinical resource; attend Care Management rounds.
- Monitor employees’ performance regularly and coach employees as needed.
- Perform other related tasks as directed or required.
Qualifications
- Bachelor’s degree, preferably in Nursing (Required)
- Current New York State RN or LSCSW license (Required)
- CCM certification (Preferred)
- 5 – 8+ years of clinical experience (Required)
- Health plan experience (Preferred)
- May be required to manage Long-Term Services and Supports (LTSS) cases (Preferred)
- Experience leading care management teams (Required)
- Detail oriented; strong analytical and problem-solving skills; ability to execute on strategy (Required)
- Ability to organize, prioritize, and effectively manage multiple tasks with competing priority levels and deadlines (Required)
- Excellent communication skills (verbal, written, presentation, interpersonal) with all types/levels of audiences (Required)
- Proficient with MS Office - Word, Excel, PowerPoint, Outlook, Teams, etc. (Required)
- Able to analyze problems and recommend and deploy strategies to improve performance in collaboration with the leadership team (Required)
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
EmblemHealth may provide work visa sponsorship depending on factors such as business unit requirements, position nature, costs, and applicable laws and regulations.