MLTC Clinical Quality Manager

MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health Hospitals, the largest public health system in the United States, MetroPlusHealth network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlusHealth has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.

Position Overview:

The MLTC Clinical Assessment Manageris responsible for supporting the day-to-day functions of the MLTC Plan. They will manage MLTC's quality control & quality improvement activities and initiatives, including overseeing the MLTC Clinical Quality Improvement Specialist, Assessment Nurses, and Assessment Coordinators. They will analyze performance and recommend improvement initiatives and/or corrective actions strategies. The MLTC Clinical Assessment Manager will oversee the quality of assessments and the care planning processes, including the quality of the finished care plans. This position will be responsible for developing, implementing, and evaluating MetroPlusHealth's MLTC performance improvement activities including, but not limited to, analyzing data to identify performance trends; prioritizing and recommending improvements and coaching staff to achieve better performance. The MLTC Clinical Assessment Manager will play a role in ensuring compliance with all State and Federal contractual requirements regarding quality management.

The MLTC Clinical Assessment Manager will anticipate and resolve complex issues and ensure accurate and quality record keeping. The MLTC Clinical Assessment Manager will work closely with the Medical Management Quality Management department as well to ensure that QM staff have access to the MLTC records and information they need. In addition to the day-to-day responsibilities, the MLTC Clinical Assessment Manager will work in conjunction with the Senior Director of Long Term Care on a variety of critical tasks.

• Creates business processes to ensure high quality and timely assessments and care plans
• Oversees the MLTC Clinical Quality Improvement Specialists who recommends appropriate services based on a standardized comprehensive assessment that initiates the service planning process
• Oversees the Assessment Nurses who conduct face-to-face telehealth assessments and Assessment Coordinators who schedule and process the assessments
• Oversees the use of Quality Software utilized in checking data consistency in all assessments conducted for MetroPlusHealth using the UAS-NY Community Health Assessment.
• Guides the Assessment nurses and the Clinical Quality Improvement Specialist in analyzing member's specific data generated from UAS-NY Assessments to enhance clinical assessment accuracy.
• Oversees the use of the Quality software in improving documentation accuracy
• Responsible in monitoring UAS activities, maintaining the Plan's membership in the Organizational case list, identifying role assignment of users and account holders in accessing UAS-NY in the Health Commerce System.
• Identifies opportunities for performance improvement in both clinical and operational areas, e.g., preventing falls, reducing readmissions, ensuring timely delivery of DME
• Manages the annual MLTC performance improvement project (PIP) including project focus, metrics development, tracking, and reporting
• Works with IPRO to ensure timely reviews of interim and year-end reports for PIP
• Develops and implement on-going staff trainings necessary for improving the timeliness and accuracy of assessment, tasking tools, and care plans
• Conducts departmental meetings and in-services associated with the implementation of new policies and procedures specific to MLTC.
• Oversees the implementation of corrective actions related to internal and external audit findings
• Identifies data resource needs and work with other departments (e.g., IT, Analytics, QM) to provide visibility for tracking and monitoring purposes
• Uses the principles of continuous quality and performance improvement to monitor functions and drive organizational improvements in processes.
• Performs periodic performance reviews and targeted audits as determined by the leadership and performance trends.
• Working with care management team, works with Regulatory and compliance to resolve and respond to NYSDOH complaints.
• Works with Quality Management to coordinate member outreach efforts to align resourcing and avoid duplication
• Follows-up to ensure corrective actions were implemented effectively for regulatory issues, compliance, or deficiencies identified in patient complaints/incidents and NYSDOH complaints.
• Regularly conducts audits of patient/member case records, and shares findings with team leads and staff members
• Develops forms, record abstracts, reports, and other tools used to implement concurrent and retrospective patient/member case review, including the design, testing and evaluation of the review methodology.
• Keeps informed of the latest internal and external issues and trends in utilization and quality management.
• Develops standards of staff performance and oversight to ensure performance indicators and program requirements are being met.
• Prepares data and written reports or materials for meetings and as required or requested by leadership.
• Evaluates and assesses staff on an on-going basis, offering oral and written counseling as deemed required.
• Performs other duties as directed and as necessary.

• Registered Nurse with a current licensure in NYS. Bachelor's Degree required.
• A minimum of three years' experience in an MCO setting, preferably with MLTC.
• Minimum of three years managerial experience.
• Excellent communication, written and analytical skills.
• Knowledge of computers and healthcare information systems.
• Highly organized skills required.
• Ability to work in a fast-paced environments requiring technical clinical expertise.

Preferred Qualifications

• Experience with geriatric population
• Certification in Case Management
• Knowledge and expertise of care management-based computer systems and Microsoft office products.
• Experience with Medicaid recipients and community services
• Experience in managed care and/or care management

Required Education, Training & Professional Experience:

• Registered Nurse with current licensure in NYS

Professional Competencies:

• Integrity and Trust
• Customer Service Focus
• Functional/Technical skills
• Written/Oral Communications

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