Quality Management Health Navigator Job Ref 106120 Category Member Services Department QUALITY MANAGEMENT Location 50 Water Street, 7th Floor, New York, NY 10004 Job Type Regular Employment Type Full Time Hire In Rate $50,000.00 Salary Range $50,000.00 $60,000.00 Empower. Unite. Care. MetroPlusHealth is committed to empowering New Yorkers by uniting communities through ca

Sales Representative I Brooklyn (Bilingual Spanish) Job Ref 104596 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 $50,000.00 Salary Range $50,000.00 $50,000.00 Empower. Unite. Care. MetroPlusHealth is committed to empowering New Yorkers by uniting communities

MetroPlus Health seeks an Instructional Designer who has a passion for creating engaging, innovative, and effective learning solutions. The individual in this role will provide leadership and support for the development of the learning curriculum via different mediums. These mediums may include, but are not limited to, e learning, in class learning, presentations, etc. Jo

Product Implementation Specialist Job Ref 103924 Category Professional Department MHP PRODUCT 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 care. We belie

Responsible for providing provider onboarding, training for claims and billing procedures, contract compliance, Product, medical management, and pharmacy issues. Promotes provider compliance with local/state/region/federal regulations through provider forums and training opportunities, inclusive of behavioral health network. Job Description Provide provider onboarding alo

The Payment Integrity (PI) Analyst will assist in the development of a strategic roadmap to recover, eliminate, and prevent unnecessary medical expense spending and support the execution for a comprehensive claim accuracy program. The incumbent will optimize pre/post claim editing, auditing, and claim recovery programs that will drive incremental value year over year. The

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

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 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