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Clinical Navigation Team Mgr Care Mgmt

Today Flexible / Remote

Description and Requirements

The Manager of Care Management is responsible for supervising a team (which includes RN's, Social Workers, and Coordinators) to coordinate appropriate services and care management to members while ensuring the mission of our program is maintained. The Manager will work on Healthfirst product lines such as, CompleteCare, Medicaid, Medicare, etc. Depending on one's residence and line of business, the Manager may be expected to make home, nursing home, and other related sites visits around downstate New York.

Duties//Responsibilities:

• Develops and monitors team goals; provides ongoing feedback and coaching; conducts annual performance reviews; leads by example; routinely evaluates staff's clinical skills and technical comprehension; and ensures an atmosphere of open communication, teamwork, and empowerment to make informed decisions

• Maintains and recommends appropriate staffing levels to guarantee safe and effective care management

• Oversees continuation, coordination, and delivery of individualized care plans and authorized services

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• Collaborates with each Clinical Operations' core areas as needed

• Assists in analyzing reviews, metric data, and PHI audits and uses that information to identify opportunities for improvement

• Additional duties as assigned



Minimum Qualifications:

• Associate's degree

• NYS RN, LSW or other relevant clinical license



Preferred Qualifications:

• CCM certification

• Supervisory or training experience

• Relevant clinical work experience

• Knowledge of member satisfaction//incident management and regulations

• Knowledge of quality improvement methodologies

• Demonstrated professionalism and leadership skills along with ability to develop, direct, and support a team

• Time management, critical//creative thinking, communication, and problem-solving skills

• Adept at planning, organizing, and executing

• Knowledge of health insurance, Medicaid, Medicare and MLTCP

• Care management experience in a clinical managed care environment and knowledge of best practices

• Knowledge of UM//QM case philosophies and reporting requirements to state and federal agencies

• Ability to allocate, monitor, and control resources while delegating and monitoring workloads

• Ability to effectively manage performance as well as set and achieve goals



Compliance & Regulatory Responsibilities:

• Ensures Care Management team meets department and regulatory requirements

• Guarantees care plans are revised and updated according to regulatory requirements and as a member's condition(s) changes in the multiple PHI databases, especially TruCare. Supervises and audits compliance including HIPAA standards, for confidentiality and management of PHI plus Care Management Team entries in varied electronic PHI storage systems (e.g.: Macess, TruCare, and EMR).

Hiring Range
:

  • Greater New York City Area (NY, NJ, CT residents): $100,900 - $145,775
  • All Other Locations (within approved locations): $86,500 - $128,690
    As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.

    In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.

    *The hiring range is defined as the lowest and highest salaries that Healthfirst in "good faith" would pay to a new hire, or for a job promotion, or transfer into this role.

    WE ARE AN EQUAL OPPORTUNITY EMPLOYER. HF Management Services, LLC complies with all applicable laws and regulations. Applicants and employees are considered for positions and are evaluated without regard to race, color, creed, religion, sex, national origin, sexual orientation, pregnancy, age, disability, genetic information, domestic violence victim status, gender and/or gender identity or expression, military status, veteran status, citizenship or immigration status, height and weight, familial status, marital status, or unemployment status, as well as any other legally protected basis. HF Management Services, LLC shall not discriminate against any disabled employee or applicant in regard to any position for which the employee or applicant is otherwise qualified.

    If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to careers@Healthfirst.org or calling 212-519-1798 . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within HF Management Services, LLC will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with HF Management Services, LLC.

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Client-provided location(s): Flexible / Remote
Job ID: healthfirst-R020999
Employment Type: OTHER
Posted: 2025-10-15T20:20:13

Perks and Benefits

  • Health and Wellness

    • Health Insurance
    • Health Reimbursement Account
    • Dental Insurance
    • Vision Insurance
    • Life Insurance
    • Short-Term Disability
    • Long-Term Disability
    • FSA
    • HSA
    • Fitness Subsidies
    • Mental Health Benefits
    • Pet Insurance
  • Parental Benefits

    • Birth Parent or Maternity Leave
    • Family Support Resources
  • Work Flexibility

    • Remote Work Opportunities
    • Hybrid Work Opportunities
  • Office Life and Perks

    • Commuter Benefits Program
    • Casual Dress
    • Happy Hours
    • Company Outings
    • Holiday Events
  • Vacation and Time Off

    • Paid Vacation
    • Paid Holidays
    • Personal/Sick Days
    • Volunteer Time Off
  • Financial and Retirement

    • 401(K) With Company Matching
    • Performance Bonus
  • Professional Development

    • Internship Program
    • Tuition Reimbursement
    • Promote From Within
    • Access to Online Courses
    • Lunch and Learns
    • Associate or Rotational Training Program
    • Learning and Development Stipend
  • Diversity and Inclusion

    • Employee Resource Groups (ERG)
    • Woman founded/led
    • Diversity, Equity, and Inclusion Program

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