Quality Management Analytics Manager Job Ref 102881 Category Quality Assurance Department QUALITY MANAGEMENT Location 50 Water Street, 7th Floor, New York, NY 10004 Job Type Regular Employment Type Full Time Hire In Rate $121,000.00 Salary Range $121,000.00 $131,000.00 Empower. Unite. Care. MetroPlusHealth is committed to empowering New Yorkers by uniting communities thro

The Product Specialist, Medicare is a critical role in support of the efficient functioning of the Medicare product team. The Product Specialist, Medicare will perform complex and diverse duties, assist in problem solving, program/project planning, development, and execution of stated goals and objectives. Job Description Work with Product leads on product, enrollment and

Partnership in Care Operations Manager Job Ref 100146 Category Utilization Review and Case Management Department PARTNERSHIP IN CARE Location 50 Water Street, 7th Floor, New York, NY 10004 Job Type Regular Employment Type Full Time Hire In Rate $97,000.00 Salary Range $97,000.00 $107,000.00 Empower. Unite. Care. MetroPlusHealth is committed to empowering New Yorkers by un

Educate and enroll Medicaid eligible for the MetroPlusHealth Managed Long Term Care product. Identify eligible Medicaid consumers via Home Care Agencies, Adult Day Care Centers, DME Provider offices, Caregiver Resources Centers, specialty provider offices, HHC Long Term Care Facilities, etc. Understand and apply all policies and procedures pertaining to Disclosures and pr

The Provider Configuration Analyst will be responsible for the configuration of MetroPlusHealth's systems to ensure that claims are processed according to Provider contracts. Job Description Configure provider reimbursement and create and maintain fee schedules Apply technical and business knowledge to analyze departmental requirements needed to develop long and short ter

The Project Manager II (PM II) will be responsible for developing and overseeing the operational aspects and scope of a project, generally with system wide implications. The PM II creates and executes project plans and business requirements. They also effectively apply project methodology and enforce standards while ensuring quality assurance procedures. Job Description O

Medicare Sales Representative II Job Ref 105948 Category Sales Department FACILITATED ENROLLMENT Location 50 Water Street, 7th Floor, New York, NY 10004 Job Type Regular Employment Type Full Time Hire In Rate $64,911.00 Salary Range $64,911.00 $64,911.00 Empower. Unite. Care. MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We be

The purpose of this position is to provide analysis as well as monitor, guide and enhance the processes related to the assessment, build and ongoing maintenance of providers, groups, and IPAs for new and existing contracts. This role requires intra departmental communication, process management and collaboration with our Contracting, Credentialing, Provider Network Operat

The Care Manager, under the direction of the Vice President of Clinical Services, is primarily responsible for managing both simple and complex medical cases to achieve high quality patient care outcomes and minimize unnecessary medical expenses, through the coordination of services, both outpatient and inpatient. The Care Manager will assist the provider in directing car

The Care Manager Level II is the experienced, role model, and efficient member of the Case Management Program team. The Care Manager II works hand and hand to provide support and assistance to Level 1 Care Managers when needed, acting as a preceptor in the Department. With the goal of optimizing members' health care and delivery of care experience and improving quality of

Director of Long Term Care Clinical Programs Job Ref 103085 Category Utilization Review and Case Management Department MANAGED LONG TERM CARE Location 50 Water Street, 7th Floor, New York, NY 10004 Job Type Regular Employment Type Full Time Hire In Rate $155,000.00 Salary Range $155,000.00 $170,000.00 Empower. Unite. Care. MetroPlusHealth is committed to empowering New Yo

Customer Services Representatives (CSRs) are responsible for providing comprehensive high quality service to all customers. The primary responsibilities, include but are not limited to, answering customer calls, proactively working to resolve our members and providers questions and concerns, responding to and documenting all customer encounters, intaking complaints, condu

Provider Network Reimbursement Analyst Job Ref 105872 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 $65,000.00 Salary Range $65,000.00 $75,000.00 Empower. Unite. Care. MetroPlusHealth is committed to empowering New Yorkers by uniting communities t

Under the direction of the Director of Care Management (PIC), the Health & Wellness Advisor Level 2 (RN) ensures the promotion of health and wellness of HIV positive, homeless, and transgender members through the development and oversight of an evidence informed, individualized Plan of Care that addresses their complex medical, behavioral health and social service needs.

The primary goal of the Care Manager is to optimize members' health care and delivery of care experience with expected cost savings due to improved quality of care. This is accomplished through engagement and understanding of the member's needs, environment, providers, support system and optimization of services available to them. Care Manager is expected to assess and ev