Care Management and LTSS Supervisor- D-SNP and MAP

The Supervisor of MAP Care Management and LTSS provides direct leadership to care management staff, oversees utilization management and transitions of care, and is accountable for performance related to CMS Star Ratings, HEDIS measures, and internal quality benchmarks. This role partners closely with the Quality, Compliance, Medical Management, Utilization Management, and Analytics teams to ensure audit readiness, accurate reporting, and continuous performance improvement.

• Provide day‑to‑day operational oversight of MAP LSSS care management activities.
• Ensure compliance with CMS care management, utilization management, transitions of care, and documentation standards.
• Oversee adherence to policies, procedures, workflows, and regulatory updates impacting MAP and LSSS populations.
• Supervise and support care managers in completing assessments, reassessments, care planning, member outreach, and documentation within required time frames.
• Directly lead care management staff, providing coaching, guidance, and performance oversight.
• Monitor staffing levels, caseload distribution, and productivity to ensure appropriate coverage and alignment with program expectations.
• Support onboarding, training, and ongoing competency development related to CMS requirements, Stars, HEDIS, and care management best practices.
• Facilitate regular team meetings and case conferences.
• Ensure timely completion of comprehensive health risk assessments, reassessments, individualized care plans, and required member outreach.
• Monitor utilization management processes, including service authorizations, extensions, and monitoring of high‑cost, high‑risk, and vulnerable members.
• Monitor transitions of care across inpatient, skilled nursing, home, and community settings to support continuity of care and reduce avoidable utilization.
• Promote person‑centered, evidence‑based, and cost‑effective care planning consistent with CMS and organizational standards.
• Maintain direct accountability for care management performance, ensure care managers understand their role in closing care gaps, improving outcomes, and supporting Stars and HEDIS success.
• Utilize data, audits, and trend analysis to drive continuous quality improvement initiatives.
• Support member experience initiatives and address escalated care management or service issues as needed.
• Support development and monitoring of corrective action plans when performance standards are not met.
• Other duties as assigned.

• Nursing:
  License and current registration as a Registered Professional Nurse in New York State.
  
  Education:
  
  Bachelors degree in nursing, healthcare administration, or related field preferred;
  Associates Degree in Nursing required.
• Valid New York State driver’s license. Hybrid role:
  Primarily home‑based with occasional in‑office or on‑site meetings.
• Minimum of 5 years of RN experience in managed care, Medicare Advantage, long‑term services and supports, or related settings. Clinical expertise in chronic disease management preferred.
• At least 2–3 years of management or supervisory experience in care management or utilization management. Strong leadership, coaching, and staff development skills.
• Demonstrated experience with CMS regulations, Medicare Advantage requirements, and LSSS populations. In‑depth knowledge of CMS Medicare Advantage, MOC, and managed care regulations.
• Case Management Certification Preferred.
• Experience supporting Stars, HEDIS, and quality performance initiatives preferred.

• Standing, sitting, bending, walking, and driving (frequently entering and exiting vehicle throughout the day) are standard postures.
• Frequently uses a laptop computer to enter orders and obtain product information.
• Sensory requirements include speech, vision, smell, and hearing.
• Lifting requirements of up to 20 pounds frequently and up to 50 pounds occasionally.
• Bloodborne Pathogens Exposure Category I – Employee has tasks that routinely involve exposure or potential exposure to blood, body fluids or tissues.

• Competitive Salary [This position is an S06 exempt position with a min‑max rate of: $99,000- $114,000…