at MetroPlus Health Plan

Job Detail




3+ years minimum experience

Schedule Type

Full Time


160 Water St, New York, NY 10038, USA




08/22/2019, 05:16 PM


Manager of Childrens Special Services #40660 Position Title: Manager of Childrens Special Service Requirements: Must have medical background experience. Under the direction of the Medically Fragile Children Medical Director, the Manger of the Children’s Special Services (MCS) serves as the clinical team leader and the Medically Fragile Children Liaison. The incumbent manages day to day activities of the Children’s Special Services clinical team. This is accomplished through hands-on, participatory management where all aspects of day to day utilization and case management operations are supervised and feedback is shared with the leadership team for the purpose of meeting program goals and the implementation of continuous quality improvement strategies. The MCS ensures high touch coordination for all Medically Fragile Children. This is accomplished by day to day supervision of the Plan’s MCMs, ensuring that the quarterly follow up calls with the Health Home care coordinators are done on a timely basis. The MCS oversees the utilization of necessary services to support children. The MCS ensures that the authorization of HCBS and the monthly and quarterly follow up assessments are conducted in an appropriate and timely fashion. The MCS facilitates the successful execution of the Integrated Clinical Management program by providing day to day supervision and applying problem solving skills to ensure the delivery of member-centered case management, improved access to community resources and improvement of overall health status of members. Minimum Qualifications: Clinical background: Registered Nurse licensure required Minimum of 5 years-experience as a pediatric nurse, experience with Care at Home/ Medically Fragile Children strongly preferred. An equivalent combination of training, educational background and experience in related fields and educational disciplines. A minimum of 3 years of UM or CM experience in a health care and/or Managed Care setting required. Minimum of 2 years managerial/leadership experience in a Managed Care and/or health care setting required. Proficiency with computers navigating in multiple systems and web based applications Confident, autonomous, solution driven, detail oriented, high standards of excellence, nonjudgmental, diplomatic, resourceful, intuitive, dedicated, resilient and proactive Strong verbal and written communication skills including motivational coaching, influencing and negotiation abilities Excellent time management and organizational skills Strong problem solving skills Ability to prioritize and manage changing priorities under pressure Proficient in Microsoft Office applications including Word, Excel, and PowerPoint and Outlook. Ability to proficiently read and interpret medical records, claims data, pharmacy and lab reports, and prescriptions required Ability to work closely with Health Home care coordinators, HCBS and other clinical providers. Ability to form effective working relationships with a wide range of individuals. Licensure and/or Certification Required A valid address RN license. Bachelor’s Degree required, Masters preferred