• Enrollment Manager- MLTC

    Job Locations US-NY-Staten Island
    ID 2018-1059
    Category
    Clinical- MLTC
    Type
    Regular Full-Time
  • Overview

    The Enrollment Manger will be responsible for ensuring clinical supervision of staff and ensure the delivery of all member services.

    Responsibilities

    • Provide training and direction to support Enrollment Specialist - RN effectively completing assigned responsibilities; UAS, interpreting regulations, policies, operational procedures and objectives; reviewing operations in assigned area to ensure a high level of quality that is consistent with organizational standards.
    • Participates in utilization review activities; perform case management analysis; and oversees concurrent review functions with appropriate follow-up action plan and intervention.
    • Reviews/investigates difficult and/or exceptional pre-authorization cases providing feedback to member, provider, and care team. Participates in performing root-cause analyses relative to adverse events or performance improvement strategies as indicated.
    • Responsible for the day-to-day management and operations of the Enrollment Department, monitors nursing staff assignments, caseloads, service utilization, and team productivity.
    • Provides direct supervision to Field staff.
    • Ensures all documentation is timely and accurate, including Uniform assessment, reassessments, Plans of Care and encounter visit documentation.
    • Participates and provide training and continuing education as necessary.
    • Evaluates and ensures competency requirements are met for all clinical staff.
    • Identifies appropriate staffing patterns and needs of assigned staff.
    • Provides Director of Clinical Service with census, staffing, team productivity and other reports as requested.
    • Responsible for performance evaluations and disciplinary action of all assigned staff.
    • Coordinates appropriate communication and documentation between members, agency, medical professionals, and referral sources.
    • Evaluates and suggest revisions to clinical documentation system (UAS-NY) as advise by the UAS-NY reviewer team.
    • Evaluates nursing documentation.
    • Assists with assigned performance improvement data collection.
    • Implements performance improvement plan as directed.
    • Ensures compliance with State and Federal Home Health regulations.
    • Ensures compliance with Extended MLTC policies and procedures.
    • Demonstrates sound judgment by taking appropriate actions regarding suspected violation of corporate compliance regulations.
    • Reports all suspected violations to Director of Clinical Services, Compliance Officer or Compliance Hotline.
    • Performs other duties as assigned

    Qualifications

    • Graduate of an accredited School of Nursing required. BSN preferred.
    • Current Registered Nurse License with NYS Department of Education required.
    • 3 years of hospital based Care Management experience including Utilization Review and Discharge Planning experience.
    • 3 years of Managed Long Term Care enrollment based experience.

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