Manager, CompleteCare RN - Telecommuter

US-NY-New York
Requisition ID


Healthfirst is a provider-sponsored health insurance company that serves more than 1.2 million members in downstate New York. With more than 4,000 employees, a network of nearly 30,000 providers, and revenues in excess of $8.6 billion, Healthfirst is one of the largest health plans in the New York City area.   Our members are our North Star, and our mission is guided by their needs and preferences in ensuring a superior experience and access to the highest quality healthcare when and where they need it. Healthfirst’s commitment to quality and member satisfaction has helped us earn top ratings for HMO health plans in New York City. We know that employees shape our company and connect us to our communities, and we look to recruit and retain intelligent, driven leaders who are passionate about healthcare and embody our five culture drivers: - Dream Big, Plan Wisely - Break Down the Walls - Think Critically, Speak Up, Deliver with Pride - Inspire Through Trust, Lead By Example - Be Unstoppable Position Summary: The Manager, Complete Care Clinical Manager assumes a leadership role for Healthfirst's Medicare/Medicaid members and providers to insure high quality, cost-effective patient care as well as appropriate allocation of member services and resources. Healthfirst CompleteCare (HMO SNP) is a Fully Integrated Dual Eligible Medicaid Advantage Plus Special Needs Plan (SNP) that combines Medicare and Medicaid benefits with added long-term care services, specifically designed for those who require nursing home level of care.    Healthfirst is an Equal Opportunity Employer and does not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity or expression, veterans, disability status or any other characteristic protected by law.


Duties and Responsibilities:


  • Oversees the provision of Care Management functions which include: pre-certification, concurrent review, discharge planning, case management, disease management and referrals.
  • Trains new staff and provides ongoing training as necessary. Maintains staff productivity, effectiveness and efficiency.
  • Develops key indicators for staff; audits staff to achieve key indicators and optimal outcomes.
  • Develops and analyzes operational and analytical reports needed to monitor and track operational efficiency.
  • Ensures compliance with the stated goals of the Integrated Products Management Department and the overall organization.
  • Conducts daily, weekly, monthly and quarterly meetings with staff to review process issues; attends case manager meetings to review and monitor ongoing cases.
  • Performs audits of care management staff to ensure accurate and consistent application of the case/care management criteria among reviewers to ensure that staff are maintaining appropriate timeliness
  • Measures the accurate implementation of appropriate clinical interventions to ensure comprehension and compliance with internal and Regulatory workflows
  • Works with senior management to perform analyses of results/outcomes/trends and implements interventional strategies as suggested.       Works on continual process improvement as well as the development of standardized processes
  • Manages professional staff who perform care management activities for members with special needs as well as for members with mental health/substance abuse issues
  • Acts as a clinical resource/educator for the multi-disciplinary health care team on an ongoing basis in order to maximize quality of patient care as well as effectively manage their chronic disease or complex conditions
  • Contributes to the development of patient-focused care and care plans
  • Assist in identifying opportunities for and facilitating alternative care options based on member needs and assessments.
  • Additional duties as assigned
  • After training at our NYC Corporate Headquarters, position telecommutes from home when not needed in the office.
  • Minimum monthly office coverage at NYC Corporate Headquarters
  • Other duties as assigned to meet the business needs


Minimum Qualifications:


  • Associate's degree in Nursing 
  • NY State RN License. 
  • Proficiency with Corporate Email System (i.e. Outlook, Lotus Notes, etc.), MS Word, Excel, Electronic Medical Records, Database Searching, Archiving/Scanning.
  • Experience with case management and/or utilization management with Medicare and NY Medicaid regulations.
  • Experience with supervising staff or project management.
  • Excellent verbal/written communication and team-building skills a must.
  • Demonstrated ability to work in a fast-paced environment and enhance team productivity essential.

Preferred Qualifications:


  • Bachelor’s Degree in Nursing and NYS RN license
  • Experience leading assignments and projects including delegation of responsibilities and achieving deadlines.
  • Advanced clinical and home health care knowledge.
  • Technical experience managing patient health information (PHI) in a database module and archival system (e.g. Macess).
  • Thorough knowledge of current community health practices for the frail adult and working with cognitive impairments particularly in the senior population.
  • Working knowledge of the interdisciplinary model of care management. Excellent communication skills and demonstrated ability to work well with members and their families in dealing with sensitive issues.
  • Ability to facilitate problem-solving, manage many details and handle emergency situations and communicate results in a succinct and clear written manner.
  • After initial training and when not required to be in the office (to provide coverage on a rotating basis), this position will be based remotely from home.
  • Proficiency in navigating internet browsers, computer hardware and multi-tasking with multiple electronic documentation systems (toggling). Microsoft Word, Excel, time tracking, corporate email system and ability to manage electronic patient health information (PHI).
  • Supervisory experience and demonstrated ability to supervise 10-25 employees including interviewing, training, performance evaluation and progressive corrective action.
  • Excellent written communication and the ability to document grammatically correct notes. 
  • Basic skills using security tools such as encryption, e-faxing and electronic archiving.

License or Certification: RN


Regulatory or Compliance activities: n/a


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