Senior Manager Clinical Eligibility

The Senior Manager of Clinical Eligibility will have knowledge of the current assessment process for both Medicaid and Medicare programs. This position supports the Assessment Managers in planning, directing, and implementing processes to achieve successful outcomes and goals. The Senior Manager conducts and contributes to member and family education regarding health management and community resources to enhance population health. The role is responsible for the overall administration, development, and operation of the Assessment team.

• Participates in all aspects of personnel management to ensure appropriate staffing, orientation, support, discipline, and timely performance appraisals.
• Meets regularly with direct reports to review goals, trends, and performance measures and to facilitate change.
• Participates in continued staff development to improve the decision‑making process.
• Provides administrative on‑call coverage to troubleshoot and coordinate the delivery of care and services to members.
• Manages Assessment Managers to ensure timely assessments and targeted interventions to meet a member’s changing condition(s).
• Supports the care‑management teams to ensure effective care management and oversight of home vendor services.
• Supervises and directs the completion of assessments at established intervals to coincide with care‑plan development/revision and ensures early identification and action to address emergent issues.
• Assists members and prospective members with assessment and clinical eligibility questions.
• Coordinates with contract services to ensure understanding of the MLTC model, FIDA, MAP, and MMCP and cooperation with the assessment process.
• Ensures coordination with home health, nursing, and social work care as it relates to the care plan.
• Facilitates problem solving by coordinating case conferences and investigations with the care teams.
• The Senior Manager of Clinical Eligibility functions as a facilitator for the team and managers to ensure smooth workflow, efficiency and success within the four programs: PHSP, CC, AE, and SHP.
• Functions as a liaison to ensure process coordination with different organizational departments such as Intake, Medical Records, CMT, IT, HR, and Marketing.
• Performs additional duties as assigned.

• NYS licensed RN.
• Strong interpersonal skills when interacting with frail adult populations, their families, and community care providers.
• Ability to handle rapidly changing crisis situations while still achieving department goals and objectives.
• Understanding of and sensitivity to cultural differences and needs of the community in a diverse and multi‑cultural work environment.
• Proficiency in Microsoft Office (Word, Excel, Outlook, PowerPoint, Access, Adobe, Visio) and project management tools.
• Proficient navigating internet browsers, computer hardware, and multiple applications simultaneously, using encryption security tools, multiple electronic PHI databases, working with a VPN and Citrix platform and very accurate typing skills.
• Demonstrated professionalism and leadership skills with the ability to develop, direct, and support staff.
• Experience in a home‑care environment; acute, sub‑acute or long‑term care (LTC) setting; or managed‑long‑term care (MLTCP).
• Experience in one of the following areas: managed‑care organization, PACE, MLTCP, CHHA, licensed agency, or a Lombardi program.
• Excellent communication, time‑management, writing, critical‑thinking and problem‑solving skills.
• Supervisory, training, or management experience.

• Knowledgeable of state and federal regulations, including experience interpreting those regulations as they pertain to different programs.
• Understanding of cultural diversity with…