The primary function of the Quality Management (QM) Health Navigator is to outreach members missing important health screenings (i.e., HEDIS/QARR gaps in care) to assist in coordinating needed appointments for a variety of clinical and social services and ensuring maintenance medications are filled regularly. The QM Health Navigator will serve as a source of empowerment f

Customer Success Specialist (Bilingual Korean) Job Ref 81576 Category Member Services Department MHP CUSTOMER SUCCESS Location 50 Water Street, 7th Floor, New York, NY 10004 Job Type Regular Employment Type Full Time Hire In Rate $45,277.00 Salary Range $45,277.00 $45,277.00 Empower. Unite. Care. MetroPlusHealth is committed to empowering New Yorkers by uniting communitie

Educational/Enrollment Process Educate and provide assistance to qualified individuals with applying for coverage through the NY State of Health Marketplace in a Qualified Health Plan (QHP) and insurance affordability programs such as Medicaid and Child Health Plus. Assist consumers/applicants with calling the NY State of Health Customer Services Department for assistance

Customer Success Specialist (Bengali / Hindi / Urdu) Job Ref 81577 Category Member Services Department MHP CUSTOMER SUCCESS Location 50 Water Street, 7th Floor, New York, NY 10004 Job Type Regular Employment Type Full Time Hire In Rate $45,277.00 Salary Range $45,277.00 $50,000.00 Empower. Unite. Care. MetroPlusHealth is committed to empowering New Yorkers by uniting comm

Customer Success Specialist (Bilingual Chinese) Job Ref 81579 Category Member Services Department MHP CUSTOMER SUCCESS Location 50 Water Street, 7th Floor, New York, NY 10004 Job Type Regular Employment Type Full Time Hire In Rate $45,277.00 Salary Range $45,277.00 $50,000.00 Empower. Unite. Care. MetroPlusHealth is committed to empowering New Yorkers by uniting communiti

Senior Account Manager, Provider Engagement Job Ref 105307 Category Professional Department Provider Network Operations Location 50 Water Street, 7th Floor, New York, NY 10004 Job Type Regular Employment Type Full Time Hire In Rate $90,000.00 Salary Range $90,000.00 $101,000.00 Empower. Unite. Care. MetroPlusHealth is committed to empowering New Yorkers by uniting communi

Senior Account Manager, Provider Engagement Job Ref 105314 Category Professional Department Provider Network Operations Location 50 Water Street, 7th Floor, New York, NY 10004 Job Type Regular Employment Type Full Time Hire In Rate $91,000.00 Salary Range $91,000.00 $101,000.00 Empower. Unite. Care. MetroPlusHealth is committed to empowering New Yorkers by uniting communi

The Behavioral Health UM Care Coordinator provides comprehensive service and support to providers and members as needed. The primary responsibilities include but are not limited to responding to all provider inquiries for Behavioral Health Core and HARP authorizations, documenting such contacts into the tracking clinical system, manage and maintain inbound queues for the

Under the supervision of the Director of Long Term Care Clinical Programs, the MLTC Care Manager Team Lead is responsible for the day to day supervision of a team of care managers within the MLTC department as they strive to keep our members safe and thriving at home. The Care Manager (CM) Team Lead provides comprehensive support and guidance on processes/workflows, ident

Under the direction of the Assessment Nurse Team Lead, and in collaboration with the member's Care Manager, this role will conduct an in person home visit for MLTC and MAP members at a 6 month interval from the member's UAS. The home visit includes a brief health assessment on medical and behavioral health topics as well as a quick environmental scan of the member's home.

Reporting to the Vice President of Provider Network Operations, the Director of Provider Engagement will lead the Provider Engagement team and have overall accountability to develop and maximize improved alignment, driving high performance and provide world class engagement experience with identified key providers. By leading market level projects and strategies for provi

Director of Provider Data Integrity and Program Management Job Ref 105326 Category Professional Department Provider Network Operations Location 50 Water Street, 7th Floor, New York, NY 10004 Job Type Regular Employment Type Full Time Hire In Rate $145,000.00 Salary Range $145,000.00 $155,000.00 Empower. Unite. Care. MetroPlusHealth is committed to empowering New Yorkers b

Identify prospective enrollees and determine eligibility for participation in MetroPlusHealth's Medicare product. Understand and apply all policies and procedure pertaining to Disclosures and provisions of the MetroPlusHealth Medicare product. Enrollment and disenrollment. Conduct home visits, and personalized appointments as needed to complete the enrollment process. Mar

Collaborate with the internal and external teams to develop and maintain the MLTC/MAP disenrollment operational processes and procedures. Coordinate the MLTC/MAP enrollment and disenrollment workflow. Troubleshoot cases which require further investigation by Marketing or Maximus to complete the eligibility and enrollment process Provide feedback regarding eligibility or e

Manager of Call Center Quality and Compliance Job Ref 104050 Category Call Center Department CALL CENTER Location 50 Water Street, 7th Floor, New York, NY 10004 Job Type Regular Employment Type Full Time Hire In Rate $75,000.00 Salary Range $75,000.00 $85,000.00 Empower. Unite. Care. MetroPlusHealth is committed to empowering New Yorkers by uniting communities through car