Job Title

The challenges of affordable healthcare continue to create new opportunities. Elderplan and HomeFirst, our Medicare and Medicaid managed care health plans, are outstanding examples of how we are expanding services in response to our patients' and members' needs. These high-quality healthcare plans are designed to help keep people independent and living life on their own terms.Care Management Supervisor of Quality Review & Staff Education is responsible for quality assurance, accuracy, and overall integrity of the care management records completed by Care Management staff. This role is to ensure compliance with NYS DOH and CMS regulations through development of auditing tools and data validation. This Supervisor is responsible to analyze collected audit data, identify trend for staff re-training, and implementing corrective action plans in collaboration with Clinical Management and Staff Education. Oversees and conducts orientation, training and education to all members of Care Management team. Provides support to Director and Managers of Coordinated Care to ensure that all reporting requirements are prepared, submitted, and maintained in a professional and well-coordinated manner.  Baccalaureate Nursing Degree from an NLN-Accredited School of NursingExperience and knowledge of Managed Care: A minimum of two years nursing experience in Community Health or related field and/or minimum of two years of progressive job-related experience, including care management and coordination, education and supervisionDemonstrates strong critical-thinking, problem-solving skills and knowledge of Medicare and MedicaidEffective communication skills, both written and oral Possess strong critical thinking skills and knowledge of Medicare and Medicaid regulationsExcellent analytical skill, interpretation of dataAbility to set priorities and to handle multiple assignments Working knowledge of audit techniques and methodologies Secures relevant information to identify potential problems and makes recommendations for appropriate solutionsWork effectively within interdisciplinary team environmentComputer literate, Windows, Excel, Word, Visio and data base programs required. PowerPoint preferredWorking knowledge of State and Federal regulations