MetroPlus jobs in New York, NY - 51 jobs

Department: CLAIMS Job Type: Regular Employment Type: Full-Time Salary Range: $65,000.00 - $74,655.00 Empower. Unite. Care. MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day. About NYC Health + Hospitals 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's 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. Position Overview The Medical Payments and Fee Schedules Analyst will lead the analysis, development, and implementation of payment rates and fee schedules. Collaborate with a multidisciplinary team to interpret existing and develop new fee schedules and payment rates for medical services. Conduct financial modeling, impact analyses, and audits to assess variations in reimbursements. Perform research to aid in the development of a base fee schedule. Serve as subject matter expert in all areas of fee schedules, rate reimbursements, and payment methodologies. Facilitate the integration of contract payment terms into the claims processing system and comprehensively understand the downstream impact of loaded rates within the Plan's entire claims reimbursement cycle. Identify, correct, and perform root cause analyses of fee schedule loaded and reimbursement issues. The ideal candidate will have strong analytical skills, a deep understanding of healthcare reimbursement models, and experience in data reporting and analysis. Work Shifts 9:00 A.M - 5:00 P.M Duties & Responsibilities * Lead analysis of medical payment rates and fee schedules. * Oversee and verify accurate loading of fee schedules per provider contracts. * Identify, correct, and perform root cause analysis of fee schedules and reimbursement issues. * Collaborate with departments including Compliance, Claims Operation, Core Configuration, Products, Contracting, Provider Network Relations, and other related areas to ensure fee schedules and claims adjustments are timely and accurately loaded. * Ensure appropriate implementation of fee schedules and reimbursement methodologies as MetroPlusHealth transitions to value-based reimbursement. * Analyze negotiated contracts to confirm that reimbursements align with negotiated intent. * Work with a multidisciplinary team to interpret existing and develop new fee schedules and payment rates as necessary. * Serves as subject matter expert with all contract implementation for fee schedule, rate reimbursement matters, and payment methodologies. * Lead and oversee rate testing with all impacted teams within the Plan. * Analyze large data sets to identify trends and present findings with actionable recommendations to senior leaderships and other stakeholders. * Collaborate with departments across the MetroPlusHealth organization to continually understand and optimize performance. * Establish and maintain continuing collaboration with multiple departments. Triage and resolve reimbursement issues. * Organize, log and create categorization of issues for long-term resolution and trend analysis. * Create and execute plans for reimbursement projects, including identifying high-volume providers, setting resolution goals and working with internal departments to achieve Key Performance Indicator (KPI). * Access various systems and analytical tools, including SQL, Tableau, Epace, Microsoft Offices to provide solutions to reimbursement issues. * Use various data elements (including the dates of service, provider type, lines of business and servicing locations etc) to validate accuracy of reimbursements. Minimum Qualifications * Bachelor of Science in Business, Finance, Economics, Information Systems, Healthcare Administrations or equivalent. * Minimum 5 years of relevant experience, preferably in a health care environment. * Strong knowledge of CMS, New York State Medicaid, and third-party fee schedules, as well as industry wide payment methodologies, and claims edit policies required. * Proficiency with Microsoft Excel including LOOKUPs, Pivot Table and Macros. * Excellent understanding of contracts, especially in a provider and payer relationship. * Excellent analytical, problem-solving, and communication skills, with the ability to present complex data in an understandable manner. * Ability to translate business process requirements into a production environment. * Strong familiarity with health plan claims/provider billing systems and interdependent applications. * Experience in data and auditing functions. * Experience in developing and improving business processes. * Knowledge of SQL/SAS/Tableau. Professional Competencies * Integrity and Trust * Customer Focus * Functional/Technical skills * Written/Oral Communication * Excellent communication and documentation skills * Ability to multi-task * Strong analytical skills and attention to detail * Analytics, problem solving, technical skills and attention to detail are required Benefits NYC Health and Hospitals offers a competitive benefits package that includes: * Comprehensive Health Benefits for employees hired to work 20+ hrs. per week * Retirement Savings and Pension Plans * Paid Holidays and Vacation in accordance with employees' Collectively bargained contracts * Loan Forgiveness Programs for eligible employees * College tuition discounts and professional development opportunities * College Savings Program * Union Benefits for eligible titles * Multiple employee discounts programs * Commuter Benefits Programs #LI-Hybrid #MHP50

Department: CLAIMS Job Type: Regular Employment Type: Full-Time Salary Range: $55,000.00 - $65,000.00 Empower. Unite. Care. MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day. About NYC Health + Hospitals 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's network includes over 27,000 primary care providers, specialists and participating clinics. For more than 40 years, MetroPlusHealth has been committed to building strong relationships with its members and providers. Position Overview The Claims Quality Analyst is responsible for reviewing claims to determine if payments have been made correctly. This position analyzes data used in settling claims to determine the validity of payment of claims and reports overpayments, underpayments and other irregularities based upon benefit configuration, compliance with provider contract agreements, and Federal, State and Plan's established guidelines and/or policies and procedures. The incumbent will research, review, and suggest process improvements, training opportunities and is a resource of information to all staff. The incumbent will also perform special projects. Work Shifts 9:00 A.M - 5:00 P.M Duties & Responsibilities * Audit daily processed claims through random selection based on set criteria. * Document, track, and trend findings per organizational guidelines * Based upon trends, determine ongoing Claims Examiner training needs, and assist in the development of training curriculum. * Conduct in-depth research of contract issues, system-related problems, claims processing Policies and Procedures, etc., to confirm cause of trends. Recommend actions/resolutions. * Work with other organizational departments to develop corrective action plans to improve accuracy of the claims adjudication processes and assure compliance with organizational requirements and applicable regulations * Assist in the development of Claims policies and procedures * Provide backup for other trainers within the department * Assist in training of new departmental staffs * Assist with the research and resolution of audit appeals * Asist with external/internal regulatory audits * Identify policies or common errors requiring retraining sessions. * Participate in quality projects as required. * Collect, analyze data, identify trends, write reports (i.e., the monthly and quarterly reports) and present findings to the appropriate claims service management personnel. * Other duties as assigned by senior management Minimum Qualifications * Associate degree required; Bachelor's degree preferred * Minimum of 4 years of experience performing claims quality audits in a NYS-based managed care setting * Expertise in both professional and institutional claims coding, and coding rules required. * Definitive understanding of provider and health plan contracting, delineation of risk, medical terminology and standard industry reimbursement methodologies required. * Strong knowledge of CMS Medicare and NYS regulations required. * Experience in training development and presentation preferred Professional Competencies * Strong organizational, analytical, and oral/written communication skills required. * Proficiency in PC application skills, e.g., excel, word, PowerPoint, etc., * Must be able to follow direction and perform independently according to departmental * Integrity and Trust * Must have excellent interpersonal, verbal, and written communication skills Benefits NYC Health and Hospitals offers a competitive benefits package that includes: * Comprehensive Health Benefits for employees hired to work 20+ hrs. per week * Retirement Savings and Pension Plans * Paid Holidays and Vacation in accordance with employees' Collectively bargained contracts * Loan Forgiveness Programs for eligible employees * College tuition discounts and professional development opportunities * College Savings Program * Union Benefits for eligible titles * Multiple employee discounts programs * Commuter Benefits Programs #LI-Hybrid #MHP50

Department: CASE MANAGEMENT Job Type: Regular Employment Type: Full-Time Salary Range: $155,000.00 - $170,000.00 Empower. Unite. Care. MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day. About NYC Health + Hospitals 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's network includes over 27,000 primary care providers, specialists and participating clinics. For more than 40 years, MetroPlusHealth has been committed to building strong relationships with its members and providers. Position Overview Under the supervision of the Senior Director of Integrated Care Management (ICM), the Director of ICM (Medicare) provides clinical and administrative oversight for the Medicare Advantage and Integrated Benefits for Dually Eligible ("IB-Dual") populations, also known as the Medicare dual eligible special needs plan (D-SNP) line of business. This role ensures adherence to the Medicare Model of Care, CMS regulatory requirements, established policies and workflows. They are also responsible for managing the day-to-day operations of the clinical and non-clinical staff, ensuring adherence to the care management process. Most broadly, the Director ensures members are receiving the care they need and that staff are addressing the members' medical, behavioral and social needs while ensuring appropriate linkages in order for them to remain safely in the community. Work Shifts 9:00 A.M - 5:00 P.M Duties & Responsibilities * Participates in the development of the vision and strategic direction for Integrated Care Management; collaborates on the implementation of related strategies. * Supervises, plans, organizes, prioritizes, delegates, and evaluates staff and functions of the Integrated Care Management Department and Medicare line of business. * Ensure staff are care managing members in accordance with the risk stratification identified and adhering to the care management process of screening, assessing, implementing, and evaluating. * Participates in development, implementation, and annual review of the Integrated Care Management and Quality Management/Quality Improvement Plan. * Provides oversight for the implementation and adherence to the Model of Care * Ensures compliance with Federal, State and City regulations as they relate to Medicare, Medicaid, and Health Homes. * Provides oversight for Transitions of Care Process and tracking, implementing strategies to prevent readmissions and reduce hospitalizations. * Collaborates with NYC H+H and external partners on various initiatives, projects and pilot programs. * Gathers, develops and tracks data on evidence-based practice interventions. * Represents ICM at various meetings and committees as required. * Provides clinical support for the review of Quality-of-Care concerns being investigated by the Quality Management Department, and collaborates with Quality Management on HEDIS, STAR ratings and CAHPS score improvement initiatives and strategies. * Collaborates with the UM Department to manage appropriate member utilization and works with data analytics to generate reports that will illustrate the impact on members' utilization. * Drives the implementation of processes and functional enhancements which will improve the overall quality and services provided by the CM teams. * Collaborate with MetroPlusHealth customer service department to ensure that member issues and concerns are addressed and resolved in a timely manner. * Analyzes trends and implements departmental initiatives based upon data provided through the reporting of Care Management or from Quality, Data Analytics and Audit data. * Ensures comprehensive and supportive on-boarding of new hires and effective, data-driven monitoring/coaching to ensure that efficiency and performance are maximized among existing staff. * Maintains communication with the department head, offering routine updates on operations, issues, concerns, and other pertinent information. * Adheres to hybrid work model and provides staff oversight on office days. * Performs other duties as assigned by the Senior Director. Minimum Qualifications * Bachelor of Science in Nursing required. Master's Degree in Nursing preferred. * Minimum 10 years professional healthcare management * Minimum 5 years in leadership role, Manager and above * A minimum of 5 years of administrative experience with supervision of clinical and ancillary staff in a Managed care role required * Must be familiar with OMH, DOH, CMS regulations for service delivery, with a care coordination approach to service delivery in managed care settings Licensure and/or Certification Required: * Valid New York State license and current registration to practice as a Registered Professional Nurse (RN) issued by the New York State Education Department (NYSED). Professional Competencies: * Integrity and Trust * Leadership and Management Skills * Customer Focus * Functional / Technical skills * Written/ Oral Communication * Ability to successfully multi-task while under strict timetable * Exceptional Organizational skills Benefits NYC Health and Hospitals offers a competitive benefits package that includes: * Comprehensive Health Benefits for employees hired to work 20+ hrs. per week * Retirement Savings and Pension Plans * Paid Holidays and Vacation in accordance with employees' Collectively bargained contracts * Loan Forgiveness Programs for eligible employees * College tuition discounts and professional development opportunities * College Savings Program * Union Benefits for eligible titles * Multiple employee discounts programs * Commuter Benefits Programs #LI-Hybrid #MHP50

Department: CLAIMS Job Type: Regular Employment Type: Full-Time Work Arrangement: Hybrid Salary Range: $76,000.00 - $86,661.00 The Inpatient-Outpatient Coder is responsible for conducting coding audits and education for providers with greatest opportunity for improvement. This individual will ensure medical diagnosis and procedure codes submitted on provider claims are accurate. In addition, this person will review medical records for: physician documentation, clinical evidence that supports the diagnoses, medical necessity of procedures, appropriate setting of care and accurate use of CMS coding guidelines. Scope of Role & Responsibilities * Identifies trends and inconsistencies in provider documentation and coding practices. * Audits and reviews medical records to determine if the medical record is complete, accurate, and in support of individual patient risk adjustment score accuracy. * Develops curriculum to improve provider coding practices. * Educates providers and their practice staff in coding guidelines. * Works in collaboration with other departments, develop plans and materials that support education and system changes to ensure proper coding is a standard practice for all providers. * Participates in the review and analysis of summary data. Assist with data collection and report generation. * Maintains the confidentiality and security of sensitive information and files. Required Education, Training & Professional Experience * Associate degree required. * 2-5 years of health care experience in a physician group practice or other ambulatory care setting preferred. * 1+ years of medical coding experience with demonstrated sustained coding quality. * In-depth knowledge of coding/classification systems appropriate for inpatient, outpatient, APR-DRG/MS-DRG and APC/APG prospective payment systems * Demonstrates advanced knowledge of CPT/HCPS/Revenue Code procedure coding, ICD-9/ICD-10 coding principles and practices. * Ability to research authoritative citations related to coding, compliance, and additional reporting requirements. * Demonstrates overall knowledge of claims processing for various insurances both private and government Licensure and/or Certification Required * Certification as a professional coder (CPC); or * Certification as an inpatient coder (CIC) Professional Competencies * Integrity and Trust * Customer Focus * Functional/Technical skills * Written/Oral Communication * Excellent verbal and written communication skills * Excellent computer skills. Able to learn, use and toggle between multiple systems. * Analytical skills and ability to create reports, charts, and graphs (e.g. Microsoft Excel) * Ability to work independently or in a team setting, while handling multiple projects and adjusting to changes quickly while meeting all deadlines #LI-Hybrid #MHP50

Department: FACILITATED ENROLLMENT Job Type: Regular Employment Type: Full-Time Salary Range: $60,000.00 - $60,000.00 MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day. The Sales Representative II is responsible for educating and assisting qualified individuals with purchasing affordable health insurance coverage and/or obtaining an eligibility determination for coverage in Qualified Health Plans (QHPs) and insurance affordability programs such as Medicaid and Child Health Plus (CHP) through the NY State of Health (MarketPlace). The Sales Representative II is responsible for identifying and educating prospective members that do not have health insurance and/or are looking to change coverage as well as assisting existing members with recertification and education of benefits. The Sales Representative II is tasked with performing all duties in accordance with the Affordable Care Act (ACA) as well as all other pertinent rules and regulations. Scope of Role & Responsibilities 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 with enrolling and/or providing verification documentation. * Conduct public education activities for consumers to raise awareness of available QHPs within the Marketplace. * Explain potential eligibility for public/governmental programs, how the federal health insurance premium tax credit and cost-sharing reductions work, and outline potential risk factor, if any, to consumers. * Describe the features and benefits of health insurance coverage, including cost-sharing mechanisms like deductibles, co-pays, co-insurance and how these work and/or affect the consumer. * Describe the different metal tiers within the Marketplace and how the benefits may change at different tiers based on the consumer's income. * Conduct presentations and participate in ACA forums and workshops upon request. * Assist consumers with submitting documents and information as required by the Marketplace via scan, fax, or mail. * Assist existing members with recertification, when applicable. * Assist consumers with the submission of premium payments when required. Regulatory/Compliance * Securing and safeguarding confidential information to prevent Protected Health Information (PHI) from being obtained from unauthorized personnel to ensure compliance with privacy and security standards. * Provide information in a manner that is culturally and linguistically appropriate to the needs of the population being served by the Marketplace. * Participate in all trainings, updates and webinars and other forums in which information is necessary to carry out roles and responsibilities. * Mandated to meet the annual Marketplace Facilitated Enroller (MFE) recertification requirements. * Keep abreast of all industry and regulatory updates as it pertains to the ACA and Marketplace. * Maintain discretion regarding business-related files, reports, and conversations within the provisions of applicable State and Federal Statutes and regulations. Tactical * Maintain a daily tracking tool that entails detailed rep activity. * Monitor all applications in personal dashboard to ensure timely and accurate follow through from applicants. * Conduct a daily review of personal dashboard to address and follow-up on any and/or all potential leads for consumers seeking assistance. * Maintain a consistent supply of various educational and product line collateral. * Keep abreast of all the Marketplace functionalities to effectively manage individual accounts. * Conduct a daily review of the MetroPlusHealth "Marketplus" lead management program to follow-up on all new potential enrollment leads and consumer inquiries. Record all follow-up dispositions in a timely and accurate manner. * Data enter all applicant demographic, enrollment site and PCP selection data in the required "Enrollment Program" within the MetroPlusHealth portal at the time of the initial enrollment encounter. * Must be in compliance with all conflict-of-interest standards and regulations. * All other tasks and responsibilities as may be required to satisfy the expectations of the role. * Required to work evenings and weekends. Required Education, Training & Professional Experience * Must have a High School Diploma or GED. * Minimum of three (3) years of Sales experience required. * Prior Public Speaking experience. Licensure and/or Certification Required * Must complete and pass the NY State of Health approved training program and become certified. Must complete all required annual recertification as an MFE Professional Competencies * Integrity and Trust * Customer Focus * Functional/Technical skills * Written/Oral Communication

Department: CORPORATE TRANSPORTATION Job Type: Regular Employment Type: Full-Time Work Arrangement: Field Salary Range: $51,000.00 - $51,000.00 Reporting to the Corporate Transportation Supervisor, the Support Driver is responsible for operating and maintaining company vehicles. The Support Driver will primarily provide support to all aspects of the Sales and Customer Success Departments' outreach and enrollment efforts - including, but not limited to daily Sales events and promotional activities. In addition, the Support Driver will support all MetroPlusHealth Departments as it relates to special requests and activities. Scope of Role & Responsibilities (URAC Core 25d) Material/Supply Administration and Outreach/Promotional Support * To deliver and distribute marketing materials, supplies and equipment as needed to Sales Representatives, Customer Success Specialists, Supervisors, and Managers at various sites. * Load and unload supplies at point of pick-up, delivery, and distribution. * Assist Sales Representatives, Customer Success Specialists, Supervisors, and Managers in setting up/breaking down equipment at events. Vehicle Use and Maintenance * Complete trip log form whenever using the vehicle. Record mileage in and out. Record all purchases of gas on the log form. * Take vehicle for necessary oil changes, service, and inspection as directed by the Assistant Director. * Maintain the upkeep of the company vehicle with gas, and car washes as necessary. * Maintain awareness of vehicle registration, permits, and insurance dates and deadlines. * Safeguard equipment within the vehicle. * Report any vehicle malfunctions, accidents, loss of vehicle identification or gas card in a timely fashion. * Vehicle identification or gas card cannot be utilized for personal use at any time for any reason. Transportation * Transport staff as needed upon request and authorization to work related meetings or special activities * Lending support to corporate initiatives (i.e.: Holiday Events, Provider Galas, Leadership Conferences), * Receiving and stocking inventory and supplies for the Sales and Customer Success Departments. Other * Assist Sales, Customer Success, and Marketing staff during routine sales outreach (operate popcorn machine, tents, gazebos, distribution of marketing collateral, etc.) * Assist at events (weekday and weekend), as well as other necessary after-hours activities as required. * Conducting outreach efforts as required * Report any changes in license status in a timely fashion license. * Maintain excellent working relationship with mailroom staff, facility loading dock/receiving personnel and warehouse staff. * Other various duties as determined by the Corporate Transportation Supervisor and Fleet Coordinator * Participation in training workshops and conferences that support the goals and objectives of the MetroPlusHealth Growth Division * Complete vehicle stock and equipment inspections and replenishment forms weekly and more frequently as needed * Arrange for the re-stock of marketing materials and promotional items to ensure minimal levels are maintained to support growth and retention efforts Required Education, Training & Professional Experience (URAC Core 25a) * A High School Diploma or equivalent is required. * Ability to operate a Motor Vehicle. * Knowledge of City parking rules and regulations preferred. * Must be able to work evenings, weekends, and flexible hours. Licensure and/or Certification Required (URAC Core 25a) * Must have a valid NYS Driver's License and maintain throughout employment. Professional Competencies (URAC Core 25a) * Integrity and Trust * Customer Focus * Functional/Technical skills * Written/Oral Communication

Department: CASE MANAGEMENT Job Type: Regular Employment Type: Full-Time Salary Range: $85,000.00 - $85,000.00 Empower. Unite. Care. MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day. About NYC Health + Hospitals 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's network includes over 27,000 primary care providers, specialists and participating clinics. For more than 40 years, MetroPlusHealth has been committed to building strong relationships with its members and providers. Position Overview 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. The Care Manager is expected to assess and evaluate member's needs, be a creative, efficient, and resourceful problem solver. The Care Manager is monitored and assessed based on value added to improved health status of member. That includes, but not limited to their disease management physical and behavioral, medication adherence, and utilization of emergency services, hospitalizations, and avoidable complications. The Care Manager's primary role is to support members in need and problem solve issues in a beneficial manner for the member and Plan. The support is comprehensive and includes clinical, social, financial, environmental and safety aspects. Work Shifts 9:00 A.M - 5:00 P.M Duties & Responsibilities * Physically meet the members where they are to gain deep understanding of their situation and needs * Problem solves member's problems and needs: clinical, psychosocial, financial, environmental * Provide services to members of varying age, clinical scenario, culture, financial means, social support, and motivation * Engage members in a collaborative relationship, empowering them to manage their physical, psychosocial and environmental health to improve and maintain lifelong well being * Assess risks and gaps in care * Maximize member's access to available resources * Prepare member-oriented plan of care with member, caregivers, and health care providers, integrating concepts of cultural sensitivity and privacy practices * Communicate plan of care to Primary Care Physician initially and no less than monthly with updates * Ensure member caregiver understanding as it relates to language barriers, stress reaction or cognitive limitations/barriers using verbal and nonverbal techniques * Train member on relevant chronic diseases, preventive care, medication management (medication adherence), home safety, etc. * Provide Complex care management including but not limited to; insuring access to care, reducing unnecessary hospitalizations, and appropriately referring to community supports * Advocate for members by assisting them to address challenges, and make informed choices regarding clinical status and treatment options * Develop collaborative relationships with clinical providers and facility staff * Employ critical thinking and judgment when dealing with unplanned issues * Ability to use data as a tool in tracking and trending outcomes and clinical information * Maintain accurate, comprehensive, and current clinical and non-clinical documents * Comply with all orientation requirements, annual and other mandatory trainings, organizational and departmental policies, and procedures, and actively participate in evaluation process * Maintain professional competencies as a Care Manager * Other duties as assigned by Team Lead and Manager. Minimum Qualifications * Master's Degree required * LMSW/LCSW with current NYS license * Minimum 3 years' prior experience in Case Management in a health care and/or Managed Care setting strongly preferred * Proficiency with computers navigating in multiple systems and web-based applications * Ability to proficiently read and interpret medical records, claims data, pharmacy and lab reports, and prescriptions required * Ability to travel within the MetroPlusHealth service area making home visits to members, facility visits to clinical providers, and visits to community, faith, and other social service-based agencies * Ability to work closely with member and caregiver. * Integrity and Trust * Customer Focus * Functional/Technical Skills * Written/Oral Communications * Confident, autonomous, solution driven, detail oriented, high standards of excellence, nonjudgmental, diplomatic, resourceful, intuitive, dedicated, resilient and proactive * Strong verbal and written communication skills including motivational coaching, influencing and negotiation abilities * Time management and organizational skills * Strong problem-solving skills * Ability to prioritize and manage changing priorities under pressure * Must know how to use Microsoft Office applications including Word, Excel, and PowerPoint and Outlook. * Ability to form effective working relationships with a wide range of individuals #LI-Hybrid #MPH50 Benefits NYC Health and Hospitals offers a competitive benefits package that includes: * Comprehensive Health Benefits for employees hired to work 20+ hrs. per week * Retirement Savings and Pension Plans * Paid Holidays and Vacation in accordance with employees' Collectively bargained contracts * Loan Forgiveness Programs for eligible employees * College tuition discounts and professional development opportunities * College Savings Program * Union Benefits for eligible titles * Multiple employee discounts programs * Commuter Benefits Programs

Department: Provider Network Operations Job Type: Regular Employment Type: Full-Time Work Arrangement: Hybrid Salary Range: $100,000.00 - $116,000.00 Empower. Unite. Care. MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day. The Manager of Provider Relations will serve as the point person for managing the day-to-day relationship between MetroPlusHealth and top level administrators at each assigned network facility and community providers. Responsible for overall provider satisfaction regarding assigned network segment and will manage respective network support team. Duties & Responsibilities * Act as a key resource to external providers and internal key stakeholders as it pertains to operational issues impacting assigned network segment. * Responsible for day-to-day business activities and managing provider relationships. * Cultivate strong partnership with assigned network facility and community providers. * Develop and implement educational processes and pro-active solutions for payment and other provider operations requirements as well as access & availability concerns * Reviews reports on annual provider satisfaction surveys; ensures the development of plans to improve identified areas of concern; work with other departments to develop quality assurance initiatives based on survey results. * Ensure segment's data integrity of provider directory, web search, etc., * Monitor/Trend Provider calls received as well as any complaints received for responsible segment * Develops processes to educate new and existing providers regarding their contractual responsibilities as well as policies and procedures. * Monitor provider concerns, collaborate and consult with internal leaders and department to improve operations and resolve issues impacting provider satisfaction and payment. * Participates in cross-functional workgroups to understand impact of plan changes and initiatives on provider network, advocating for providers as appropriate * Ensure timely responses to regulatory agencies (i.e., NYSDOH, DFS) in response to all Provider Network regulatory and compliance issues * Facilitate with marketing and retention department management to identify opportunities in current provider locations and cultivate them in viable prospects to increase MetroPlusHealth enrollment and retention efforts. * Coordinate events with the community/government agency offices within assigned network * Working collaboratively with Account Management Team, build strong partnership with provider community by cultivating open communication and ensuring Account Leads are aware of provider pain points relative to claims disputes. * Attend Joint Operating Committee meetings and takes ownership of resolving issus with assigned hospitals, etc. * Develops policies and procedures, process improvement initiatives * Manage and mentor staff to ensure job functions are completed appropriately and according to priorities * Coordinates department's efforts with those of other departments * Performs other support activites and duties as assigned Minimum Qualifications * Bachelor's degree, preferably in health care administration, and a minimum of 5 years experience in healthcare, plan or provider operations/administration/ relations or related area. * Master's degree in Health Administration preferred * Strong customer service experience with proven ability to build and maintain provider relationships * Managed care, value-baed payment model, quality and population health management experience * Knowledge of principles of business and personnel administration, management functions and support service functions and ability to direct and supervise personnel * Proficiency with Windows-based PC systems and Microsoft Office, Sharepoint * Ability to travel to meet with Providers and their representatives Professional Competencies * Integrity and Trust * Customer Focus * Functional/Technical skills * Excellent written and communication skills; ability to deliver complex information and achieve positive results * Energetic, goal driven leader with who can motivate and mobilize staff to achieve goals. * Strong problem-solving capabilities * Highly organized, detail oriented, dependable and professional individual #LI-HYBRID #MPH-50

Department: CASE MANAGEMENT Job Type: Regular Employment Type: Full-Time Salary Range: $123,588.00 - $123,588.00 Empower. Unite. Care. MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day. About NYC Health + Hospitals 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's network includes over 27,000 primary care providers, specialists and participating clinics. For more than 40 years, MetroPlusHealth has been committed to building strong relationships with its members and providers. Position Overview Under the direction of the Director of Medicaid, the Medicaid Care Manager Team Lead ensures that staff adhere to the Medicaid contractual requirements, policies and procedures, and workflows established to manage the vulnerable Medicaid population. The Medicaid Care Manager Team Lead manages the daily activities of the Medicaid team (Care Managers and Care Management Associates) to ensure quality outcomes in the delivery of member-centered case management including reduction in emergency room visits and hospital admissions, improved member satisfaction, improved member health, and cost effectiveness. Work Shifts 9:00 A.M - 5:00 P.M Duties & Responsibilities * Provide clinical guidance and supervision to assigned Care Managers and clinical support staff to promote efficient and effective delivery of care management services * Supervise day to day activities to make certain that case management services are provided in accordance with clinical guidelines, established processed and MetroPlusHealth organizational standards. * Supervise the entire care management workflow including case referrals, assignments, interventions and goal setting, follow-up/follow-through activities, documentations, and escalations. * Ensure care management activities are conducted in a safe, efficient, and effective manner to promote continuity and quality of care. * Review, develop and modify day to day workflows to ensure timely follow up. * Perform ongoing quality review of cases to ensure accuracy and compliance. * Evaluate and document staff performance; coach staff to improve both quality and quantity of skills attaining optimal performances. * Utilize data to track, trend and report productivity and outcome measures, work with the management team to implement necessary improvement strategies. * Coordinate Interdisciplinary Care Team rounds with providers, care managers and care management associates, this include scheduling meetings, identifying members for presentation, and ensuring completion and documentation of follow up activities. * Collaborate Behavioral Health to develop strategies and best practices that lead to desired goals and objectives for members who are co-managed. * Use expert verbal and non-verbal communication skills to motivate and gain co-operation of members and their caregivers. * Resolve issues and mitigate conflict encountered during daily operations, appropriately escalate issues to the Director of Medicaid * Identify and report potential risk, operational opportunities, and barriers encountered. * Conduct monthly audits for the purpose of departmental/organizational reporting and providing formal feedback to case management staff. * Create and submit operational weekly/monthly/quarterly reports. * Work with the leadership team to develop and implement ongoing training and development efforts. * Actively participate in staff training and meetings. * Encourage regular communication and inform staff of relevant departmental and organizational updates. * Develop and maintain collaborative relationships with clinical providers, facility staff and community resources. * Ensure staff comply with orientation requirements, annual and other mandatory trainings, organizational and departmental policies, and procedures. * Perform other duties as assigned by Director. Minimum Qualifications * Bachelor's Degree required, Master's in nursing preferred. * A minimum of 5 years of Care Management experience in a health care and/or Managed Care setting required. * Minimum of 2 years managerial/leadership experience in a Managed Care and/or healthcare setting required. * Proficiency with computers navigating in multiple systems and web-based applications. * Must know how to use Microsoft Office applications including Word, Excel, and PowerPoint and Outlook. * Ability to proficiently read and interpret medical records, claims data, pharmacy and lab reports, and prescriptions required * Valid New York State license and current registration to practice as a Registered Professional Nurse (RN) Issued by the New York State Education Department (NYSED). * Integrity and Trust * Customer Focus * Functional/Technical Skills * Confident, autonomous, solution driven, detail oriented, nonjudgmental, diplomatic, resourceful, intuitive, dedicated, resilient and proactive. * Strong verbal and written communication skills including motivational coaching, influencing, and negotiation abilities. * Holds themselves to high standards of excellence * Time management and organizational skills. * Strong problem-solving skills. * Ability to prioritize and manage changing priorities under pressure. * Ability to work closely with member and caregiver. * Ability to form effective working relationships with a wide range of individuals. #MPH50 #LI-Hybrid Benefits NYC Health and Hospitals offers a competitive benefits package that includes: * Comprehensive Health Benefits for employees hired to work 20+ hrs. per week * Retirement Savings and Pension Plans * Paid Holidays and Vacation in accordance with employees' Collectively bargained contracts * Loan Forgiveness Programs for eligible employees * College tuition discounts and professional development opportunities * College Savings Program * Union Benefits for eligible titles * Multiple employee discounts programs * Commuter Benefits Programs

Department: FINANCE Job Type: Regular Employment Type: Full-Time Work Arrangement: Hybrid Salary Range: $55,000.00 - $65,000.00 The Accounts Payable Analyst is responsible for managing and ensuring the accuracy and timeliness of the company's payment obligations. This role involves processing invoices, reconciling vendor accounts, ensuring compliance with company policies, and analyzing accounts payable processes for continuous improvement. Scope of Role & Responsibilities Invoice Processing * Review and verify invoices for accuracy, proper coding, and compliance with purchase orders and company policies. * Enter and process invoices into the accounting system. * Ensure timely approvals and resolution of discrepancies with vendors or internal departments. Payment Processing * Prepare and execute payments, including checks, ACH, wire transfers, and credit card transactions. * Maintain a payment schedule and ensure adherence to deadlines to avoid late fees or penalties. Vendor Management * Maintain vendor records and contact information. * Respond to vendor inquiries and resolve payment issues promptly. * Reconcile vendor statements and ensure account accuracy. Compliance & Auditing * Ensure adherence to internal controls, company policies, and regulatory requirements. * Provide documentation and support for internal and external audits. Process Improvement * Identify opportunities to streamline accounts payable processes and enhance efficiency. * Participate in implementing new tools or systems to improve workflow. * Analyze data to prepare regular scheduled specialized AP reports, analyses and statements for management review * Review and analyze statistical reports for individual customer groupings and provide support with data analysis and report preparation * Process invoices approximately 100 invoices daily * Process expense reimbursements Reporting * Assist in preparing reports to share with business stakeholders Required Education, Training & Professional Experience * Associate's degree required. Bachelor's degree preferred. * 5+ years' minimum experience in accounts payable or related roles. * Strong knowledge of accounts payable processes, general accounting principles, and financial systems. * Experience with Peoplesoft System * Knowledge of Accounts Payable system * Proficiency in accounting software Microsoft Excel. * Excellent attention to detail, organizational, and problem-solving skills. * Ability to manage multiple tasks and meet deadlines in a fast-paced environment. * Strong communication and interpersonal skills for vendor and team interactions. * Self-motivated with a proactive approach to problem-solving. * Commitment to maintaining confidentiality and professional integrity. Professional Competencies * Integrity and Trust * Customer Focus * Functional/Technical skills * Written/Oral Communication #LI-Hybrid #MHP50

Department: Provider Network Operations Job Type: Regular Employment Type: Full-Time Salary Range: $50,000.00 - $59,948.00 MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day. 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. Duties & Responsbilities * Provide provider onboarding along with any on-going trainings either at provider sites or remotely. * Organize training schedules, tracking attendees, setting up classroom and practicum trainings, finalizing the training content and handouts, etc. * Supports and maintains current provider network through customer service including training, credentialing assistance, claims resolution and advocacy. * Develops and provides a standard orientation package for newly contracted providers. * Promotes technology and skills development to improve provider business practices. * Implement processes for documenting and monitoring training program for provider compliance and program effectiveness. * Ensure contract compliance and identify areas for improvement. * Participate in cross functional teams to solve system issues. * Other duties as required and assigned by management. Minimum Qualifications * Bachelors' Degree required, preferably in health care administration, marketing, or a related area of study; and * 3-5 years' of experience in a managed care or provider organization; or * A satisfactory equivalent combination of training, education, and experience performing provider training/education or work in a related field * Experience in behavioral health field, preferred. * Ability to travel within the MetroPlusHealth service area to meet with providers and their representatives * Working knowledge of and proficiency with Windows-based PC systems and Microsoft Word, Outlook, Excel, and PowerPoint Professional Competencies * Integrity and Trust * Customer Focus * Functional/Technical skills * Ability to independently manage assigned workload, make decisions related to area of functional responsibility, and recognize issues requiring escalation * Highly organized, detail oriented, dependable and professional individual * Ability to exercise tact and diplomacy and demonstrate strong customer service skills * Ability to prepare written and oral reports and make effective presentations #LI-HYBRID #MPH-50

Department: MHP PRODUCT Job Type: Regular Employment Type: Full-Time Work Arrangement: Hybrid Salary Range: $90,000.00 - $100,000.00 Reporting to the Vice President of Product, the Product Sepcialist, Materials, ensures operational excellence and regulatory compliance owning the full spectrum of product member materials and across all Product Lines. Scope of Role & Responsibilities * Responsible for all member materials and communications under Product department and Product review. * Ensures timely cadence of required documents allowing needed time for cross-departmental collaboration. * Establishes efficient processes related to regulatory communications with an expertise on Medicare ANOC, EOC, and annual CMS and Sales materials. * Responsible for updating Model Contracts for our QHP/EP and Large group Products adhering to State deadlines. * Collaborate with internal stakeholders and Compliance to ensure all regulatory materials including member handbooks and member/provider communications, are aligned with CMS and State regulations. * Periodic review of benefits posted on MetroPlus member and provider web pages pertinent to all MetroPlus products. * Work closely with Marketing, Regulatory and Compliance to support document creation for internal and external product communication materials. * Establish and manage efficient processes for member material creation, State and CMS approvals, and mailings in compliance with State and CMS timelines. * Update Medicaid materials with regulatory model language for State submission and approval, prior to use. * Partners with the Communications Department for feedback and input on required documents * Works closely with Regulatory department for approval of documents. * Provide oversight vendor operations as they relate to required mailings with printing vendors adhering to vendor guidelines and requirements. Required Education, Training & Professional Experience: * Bachelor's degree from an accredited college or university in an appropriate discipline required. * Master's degree in business, healthcare or public administration strongly preferred. * Minimum 5 years' experience at a Health Plan in a product management or compliance role. * Knowledge of Medicaid and Medicare products and regulatory environment in NYS * Experience with CMS ANOC and EOC and NYS model contracts. * Demonstrated ability to develop and enhance processes, policies, procedures. * Demonstrated ability to identify opportunities for improvement & implement solutions. Professional Competencies: * Leadership * Results-driven * Business acumen * Systems orientation * Process improvement * Data-driven decision-making * Customer focus * Excellent written & verbal communication skills. * Resourcefulness * Ability to work effectively in a fast-paced & constantly evolving environment * Highly collaborative and demonstrating good judgment in seeking consensus & input from multiple stakeholders to drive decision-making. * Ability to take initiative & think independently * Demonstrate understanding & acceptance of the MetroPlus Mission, Vision, & Values #LI-Hybrid #MHP50

Department: INFORMATION TECHNOLOGY Job Type: Regular Employment Type: Full-Time Work Arrangement: Remote Salary Range: $146,331.00 - $156,331.00 This highly technical role is suited for a candidate with hands-on analytical experience as a network security engineer with the following background: Network routing and switching Network security appliances and applications Site-To-Site VPN, client VPN, and encryption/decryption methods Content filtering, Network Access Policies, and proxy services Our goal with the Network Security Engineer position is to improve the experience of our members, employees and coworkers, vendors, and neighbors throughout the City. Scope of Role & Responsibilities * Design, plan, install, and support network infrastructure systems with an emphasis on security engineering. * Work with vendors to plan and deploy solutions, resolve issues, and implement enhancements. * Work with UC Engineering, IT Security Ops, and Network Infrastructure teams on day-to-day operations of critical networks, application delivery, and platform security infrastructure. Required Education, Training & Professional Experience * Bachelor's degree from an accredited college/university and a minimum of 12 years of experience in designing, implementing, supporting, and monitoring enterprise networks with diverse solutions from multiple vendors on a large enterprise and global scale (Cisco, Fortinet, Arista, Aruba, CheckPoint) or * A satisfactory equivalent combination of training, education, and experience * Understanding of network and data center architectures, including both on prem and cloud architectures with experience in Microsoft Azure & AWS. * Experience in virtualization managing Microsoft Windows & Linux operating systems. * Experience with Azure, AWS, Office 365, and Azure SAML. * Understanding of networking concepts such as DNS, IP, NAT, VLANs, subnetting, etc. * Understanding of the OSI Model, web, and network protocols such as TCP, UDP and HTTP/S. * Experience supporting Unified Communications applications and Contact Centers. * Experience with load balancers such as NSX-ALB and F5. * Knowledge of PKI infrastructures. * Knowledge of information security standards. * Hands-on experience with Cisco Nexus and Catalyst switches along with Cisco ISR and CUBE routers. * Fortinet / Fortigate Security experience preferred. * Knowledge of SIP and SIP connections to cloud providers. * Experience demonstrating communication and leadership skills (must be willing to provide a high-level overview and lead/mentor/guide/influence and train other team members) * Senior level technical certification or equivalent (CISSP, CCSP, MCSA) with demonstrated relevant experience. Professional Compentencies * Leadership skills * Mentorship skills * Integrity and trust * Customer focus * Functional/Technical skills * Written/Oral Communication skills * Ability to work as a team player.

Department: MHP CORPORATE COMPLIANCE Job Type: Regular Employment Type: Full-Time Work Arrangement: Remote Salary Range: $125,000.00 - $140,000.00 Empower. Unite. Care. MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day. Reporting to the Senior Director of Corporate Compliance and Privacy, the Senior Manager of External Audits plays an essential role in supporting the Compliance Program and is responsible for overseeing external audits. The Senior Manager will lead and execute external audit engagements and drive high-quality, data-driven responses to regulatory agencies. In this role, the Senior Manager will be involved in all external audits from end-to-end, analyzing data files from regulators and internal business areas, engaging business leaders to obtain documentation and resolve issues, and preparing clear responses for submission. Duties & Responsibilities * Lead and execute external audits from regulatory agencies such as NYS Office of State Comptroller (OSC), New York State Office of Medicaid Inspector General (OMIG), Centers for Medicare and Medicaid Services (CMS), New York State Department of Health (DOH), New York State Department of Financial Services (DFS), etc. * Proactively engage with internal business areas and vendors to gather evidence, clarify processes and drive a timely response. * Analyze datasets received from regulators to assist business areas and/or vendors with their reviews. * Streamlines workflow to ensure timeliness and accuracy of compilation processes. * Prepare and review audit deliverables, response/dispute letters, and corrective action plans. * Mentor and supervisor the Manager of External Audits; set priorities and ensure consistent quality. * Responsible for the development and maintenance of tools and supporting documentation related to the external auditing process. * Provides primary support during full operational audits. * Communicates audit findings and actions required through various reporting mechanisms. * Upon identification of non-compliance, provides support to business areas in conducting a root cause analysis and corrective actions, including guidance on methodology, identification of relevant regulatory requirements and any regulatory compliance context, and Compliance review. * Plays a critical role in driving the progress for corrective actions throughout the organization. * Refers compliance matters, when necessary, to the appropriate Compliance teams to ensure proper investigation of issues. * Other activities as assigned by the Senior Director of Corporate Compliance. Minimum Qualifications * Bachelor's degree from an accredited institution * 5-7 years of experience in managed care organization compliance/auditing or healthcare compliance * Experience with managed care, Medicare and federal and/or state regulations and quality improvement. * Healthcare Compliance or Internal Audit Certification (preferred) Professional Competencies * Ability to function independently with limited direction. * Advanced Excel skills; experience manipulating large data sets and pivot tables. * In depth knowledge of health care policy environments or policy related roles with demonstrated knowledge of leading and supporting cross-departmental employee stakeholders. * Demonstrated knowledge of managing and building relationships with stakeholders, including senior management, with strong influencing and negotiation skills. * Excellent written English; able to produce polished, defensible responses. * Excellent oral communication skills, with ability to convey complex information in an accessible way as well as prepare and give presentations to diverse audiences. * Demonstrated ability to manage multiple projects, including managing departmental workload in line with the organizational strategy, successfully managing working groups, and proven project management skills. * Excellent interpersonal skills with a high level of diplomacy and political awareness, and ability to work effectively as a member of the senior management team. * Sound working knowledge of Windows-based software packages, including Word, Excel, PowerPoint, SharePoint, and Visio as well as online/Internet-based research tools. * The ability to comprehend and interpret regulatory, legislative, and contractual mandates. * High-level of skill in leading interdepartmental and cross-functional strategy development; experience managing professional staff on multiple projects to ensure corporate deadlines and objectives are met. Simultaneously, manage multiple projects. * The utmost integrity in the discreet and confidential handling of confidential materials is necessary. #LI-REMOTE #MPH-50

Department: MHP CORPORATE COMPLIANCE Job Type: Regular Employment Type: Full-Time Work Arrangement: Remote Salary Range: $93,000.00 - $103,000.00 Empower. Unite. Care. MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day. The Federal and Integrated Products Compliance Specialist reports to the Director of Federal and Integrated Product Compliance. This position will serve as the lead in the oversight and management of regulatory compliance activities for integrated products, such as Medicaid Advantage Plus (MAP), and support for federal products such as Medicare Advantage. This position will ensure operational compliance with state and federal regulations, contractual obligations, and new policy guidance. This position will also identify compliance risks through audits and monitoring driving corrective actions and remediation where necessary and ensure compliance plans and related compliance training for products under the department are accurate and updated. Duties and Responsibilities * Contribute to the Annual Compliance Risk Assessment and Work Plan. * Work cross functionally with operational departments to ensure the implementation of new regulatory guidance, updated contractual requirements, rules and regulations. Tracks related due dates and guidance and support to business areas completing deliverables. * Conduct auditing and monitoring activities as outlined in Compliance Work Plan, and as potential risks are identified. * Contributes quality and timely data for the materials prepared for both the Internal Compliance Committee and Audit and Compliance Committee of the Board of Directors. * Plays a critical role in driving the progress for corrective actions throughout the organization. Upon identification of non-compliance, provide support to business areas in conducting a root cause analysis and developing corrective actions. * Conducts auditing and monitoring to ensure compliance with requirements. * Coordinates the support for business areas in creating and updating monitoring metrics to assess continued compliance with regulatory requirements. * Ensures proper investigation of regulatory compliance related issues. * Collaborates with other Compliance Specialists to support oversight of regulatory implementation across internal and external business areas for integrated product lines, ensuring alignment with applicable requirements. * Reviewing and contributing to compliance training updates as needed. * Assists Compliance division leadership in managing regulatory audits and audit deliverables. May be asked to take a lead role in sub-assignments ensuring timely and quality deliverables to State and Federal agencies. * Review policies and procedures for adherence to regulatory and contractual requirements. Minimum Qualifications * Certified Healthcare Compliance (CHC) or Certified Compliance & Ethics Professional (CCEP) certificates are preferred * Bachelor's degree required; and * 3 years' experience in compliance, product, or operational areas; or * High school diploma/GED with 8 or more years' experience in integrated and/or federal products; or * A satisfactory equivalent combination of education, training, and experience. * Advanced degree in public health, public policy, or public administration is preferred. * Experience with integrated and federal products and services highly preferred. * High-level of skill in leading interdepartmental and cross-functional strategy development and project management. * Experience leading multiple projects to ensure corporate deadlines and objectives are met. * Experience in Microsoft Office suite products including Outlook, Excel, SharePoint, and MS Teams a plus. Professional Competencies * Integrity and Trust * Customer Focus * Functional/Technical skills * Excellent oral, written, analytical, and critical thinking skills. * Must have the utmost integrity in the handling of discreet and confidential materials. * Ability to manage multiple projects simultaneously. #LI-REMOTE #MPH50

Department: PARTNERSHIP IN CARE Job Type: Regular Employment Type: Full-Time Salary Range: $50,000.00 - $60,000.00 Empower. Unite. Care. MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day. About NYC Health + Hospitals 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's 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. Position Overview The Community Outreach Navigator under the direction of the ETE Senior Advisor plays a critical role in providing support, guidance, and advocacy to individuals living with HIV. This role is primarily responsible for communitybased engagement through home visits, health facility outreach, and collaboration with healthcare providers and community partners to re-engage patients in care and improve health outcomes. Work Shifts 9:00 A.M - 5:00 P.M Duties & Responsibilities * Conduct home, hospital, or community field visits to locate members who are lost to care or at risk of disengaging from care. * Engage patients in their homes, community locations, or healthcare facilities to assess barriers to care and support re-engagement with primary care services including accompaniment to medical or non-medical appointments. * Provide health coaching and motivational support to empower members in staying connected to HIV primary care and treatment. * Collaborate with healthcare providers, care managers, and community organizations to coordinate services that address member needs. * Schedule medical appointments, arrange transportation, and facilitate medication access to remove barriers to care. * Track all medical, behavioral, and other referrals ensuring members attend appointments, through reminder calls and accompaniment when necessary. * Monitor utilization including ER visits, hospitalization admission/discharge information, and behavioral health services to find opportunities for engagement with members. * Document outreach efforts, patient interactions, and care coordination activities in the appropriate case management systems. * Build trusting relationships with patients from diverse backgrounds using culturally sensitive and strengths-based approaches. * Participate in case conferences, training sessions, and quality improvement initiatives. Minimum Qualifications * Associate's degree with 3 years of professional experience in care coordination, health education, or case management required; OR * High school diploma/GED and 6 years' experience in care coordination, health education, or case management required. * Experience working with vulnerable or marginalized populations, including a strong knowledge of HIV. * Field work experience is preferred. * Frequent travel within the community is required. * Must be comfortable conducting home visits and outreach in diverse settings. * Must be able to navigate NYC by mass transit. * Bilingual proficiency (English/Spanish or other languages) is highly desirable. * Occasional evening or weekend work may be required. Professional Competencies * Strong interpersonal and communication skills to build rapport with patients and care teams. * Ability to navigate community settings and conduct face-to-face outreach. * Effective problem-solving and organizational skills. * Knowledge of community resources and healthcare systems. * Proficiency with Microsoft Office and electronic health record systems. * Culturally competent approach to patient engagement. Benefits NYC Health and Hospitals offers a competitive benefits package that includes: * Comprehensive Health Benefits for employees hired to work 20+ hrs. per week * Retirement Savings and Pension Plans * Paid Holidays and Vacation in accordance with employees' Collectively bargained contracts * Loan Forgiveness Programs for eligible employees * College tuition discounts and professional development opportunities * College Savings Program * Union Benefits for eligible titles * Multiple employee discounts programs * Commuter Benefits Programs #LI-Hybrid #MHP50

Department: HR OPERATIONS Job Type: Regular Employment Type: Full-Time Work Arrangement: Hybrid Salary Range: $83,000.00 - $93,000.00 MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day. Under the general direction of the Chief People Officer, the HRIS Analyst will develop and manage Human Capital data enabling the process of turning both quantitative and qualitative data and processes into metrics, measurements, and graphics-based dashboards and presentations to support the goals and objectives of the organization. Scope of Role & Responsibilities * Partner with business leaders and HR functional groups to develop a standard set of HR and talent key performance indicators. * Manage Human Capital "big data" and create a live HR dashboard showing all relevant data points including Key Performance Indicators for recruitment, onboarding, labor relations, compensation, turnover, diversity, etc. * Use creative thinking to build dashboards and design effective reporting solutions that are scalable, comprehensive, and easy to understand * Use analytical reasoning to identify problems, develop hypotheses, build connections, and recommend solutions. * Partner with business units in creating reports and queries needed to achieve operational excellence with respect to personnel, including, attendance reports, demographics reports, etc. * Design HR metrics reporting and create materials/presentations for the Chief People Officer and the Executive Team. * Maintain and update all compensation surveys including quarterly full data submissions, regular data updates, running compensation reports, etc. * Identify data collection tools, data sources, benchmarks, performance topics, and technical solutions for operational efficiency * Collect Labor Relations data and prepare reports. * Create and maintain organizational charts. * Create strategic client partnerships through regular client interaction and demonstrated leadership as representative of Human Resources * All other tasks and projects as assigned Required Education, Training & Professional Experience * A Bachelor's Degree issued from an accredited college or university with specialization in Information Technology, Human Resources, Business Administration, or related field required; and * Three (3) years of experience in data analysis, HR business systems, or other relevant experience; or * A satisfactory equivalent combination of education, training, and experience. * Knowledge of human capital metrics * Thorough understanding of all areas of information systems with a highly technical understanding of at least one commercial HRIS product. * Proficient with Microsoft Office Suite or related software. * Familiarity with human resources policies and procedures to ensure the HRIS meets organizational needs and goals. * Thorough understanding of functional analysis and system design. Licensure and/or Certification Required * Society of Human Resources Management - Certified Professional (SHRM-CP) certificate is a plus. Professional Competencies * Excellent interpersonal and technical support skills. * Excellent organizational skills and attention to detail. * Strong analytical and problem-solving skills. * Ability to keep information confidential. #LI-Hybrid #MPH50

Department: PARTNERSHIP IN CARE Job Type: Regular Employment Type: Full-Time Work Arrangement: Hybrid Salary Range: $55,000.00 - $55,000.00 Empower. Unite. Care. MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day. About NYC Health + Hospitals 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's network includes over 27,000 primary care providers, specialists and participating clinics. For more than 40 years, MetroPlusHealth has been committed to building strong relationships with its members and providers. Position Overview: MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day. With the support of the PIC Clinical Care Manager, the Health & Wellness Advisor I ensures the promotion of health and wellness among HIV-positive members and other members at high-risk for HIV by conducting high-volume outreach to assess their health and psychosocial needs and support them to stay in care and adherent to medication. The Health & Wellness Advisor I works in conjunction with the PIC Clinical Care Manager and other colleagues in a team-oriented approach with a focus on establishing member rapport. Work Shifts 9:00AM-5:00PM Duties & Responsibilities: * Promotes access to and oversees the coordination and delivery of comprehensive, quality healthcare services for members who are living with HIV, transgender, and homeless. * Performs telephonic care management activities including assessment, plan of care development, care coordination, out-patient follow-up, and ancillary service review to ensure optimum health outcomes. * Develops and implements an individualized, member-centered Plan of Care through direct telephonic and face-to-face member engagement, and inclusion, where appropriate, of collateral contacts including family members (with appropriate consent of the member), primary care provider, and other community and case managers to identify and address the needs and barriers of members living with HIV (and others in the Special Needs Plan) to promote the health and wellness of the member. * Provides health education using coaching and motivational interviewing techniques to promote improved health outcomes for HIV engagement in care and viral load suppression, engagement with behavioral health and substance use services and effective management of other co-morbid illnesses, such as hepatitis C, diabetes, hypertension, and asthma/COPD. * Participates in special outreach and quality improvement projects as assigned. * Documents all care management activities for each member and ensures that such documentation is in compliance with professional standards and regulatory guidelines using the correct templates. * Addresses member primary care provider assignment during outreach and reassigns members as appropriate. * Carefully follows designated departmental compliance, care management, and quality improvement and workflows as assigned. * Escalates cases and issues to their supervisor as appropriate. * Answers calls on the in-bound call center telephone line in a professional and timely manner. * Attends and prepares for case conferences, including Medicare interdisciplinary case conference and conferences on special topics and/or with other departments. * Orients assigned new members to MetroPlusHealth and the scope of services the plan provides as needed. * Ensures that coordination of membership enrolled in all lines of business is compliant with Federal, State, and City regulations, and are consistent with the Mission, Vision, and Values of the organization Minimum Qualifications * Bachelor's degree from an accredited college or university in a healthcare-related field is required. * Master's degree is preferred. * A minimum of two years of clinical experience in HIV care or support systems that includes experience in care coordination, health education and case management. Managed care experience is preferred. Professional Competencies: * Integrity and Trust * Customer Focus * Functional/ Technical Skills * Written/Oral Communications

Department: PARTNERSHIP IN CARE Job Type: Regular Employment Type: Full-Time Salary Range: $120,000.00 - $120,000.00 Empower. Unite. Care. MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day. About NYC Health + Hospitals 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's network includes over 27,000 primary care providers, specialists and participating clinics. For more than 40 years, MetroPlusHealth has been committed to building strong relationships with its members and providers. MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day. Position Overview: Under the supervision of the Director of Care Management, the Manager of the Partnership in Care (PIC) Department Care Management program will serve as the subject matter expert and resource for all care management activities within PIC. The Manager of Care Management supports the mission of the plan by enhancing the quality-of-care management outcomes and member satisfaction, promotes continuity of care and cost effectiveness through the integration and functions of care management. The program provides intensive, personalized member-centered care management services and goal setting for members who are living with HIV and have complex medical needs and require a wide variety of resources to manage health and improve quality of life. As a member of the PIC Department Leadership, the Manager of Care Management is responsible for the day-to-day operations in Partnership in Care Department. The Manager of Care Management serves as an educator, role model, and change agent to enhance member care and staff competency. The Manager collaborates with other departments (Utilization Management, Quality Management, Integrated Care Management, Managed Long-Term Care, Personal Care Services, Restrictive Recipient Program, Customer Success, and other MetroPlusHealth departments) to evaluate and coordinate activities and programs in support of delivery of member care. The Manager of Care Management oversees daily team operations and provides strong leadership through training, coaching, teaching, and managing assigned teams. Work Shifts 9:00 AM- 5:00 PM Duties & Responsibilities * Provides clinical guidance and supervision to all care management programs, based on accepted principles of nursing, social work, gerontology, geriatrics, HIV care and care management practice. Provides clinical perspective and best practices to staff through one-on-one coaching, group interaction at case conferences, in-service training, and other team meetings. * Oversees and manages staff responsible for patient care coordination and management which includes Health and Wellness Advisors and Clinical Care Managers Conduct monthly audits of teams and shares findings during supervision to promote accuracy and compliance. * Mentor Health and Wellness Advisors and Clinical Care Managers * Problem solves and addresses care issues requiring escalation in a manner that fosters member satisfaction and promotes quality care and service delivery. * Develops and conducts comprehensive onboarding for newly hired and existing staff. * Monitors department activities to evaluate the productivity and quality of programs and processes to identify potential improvement opportunities and to drive towards optimal performance. * Actively participates in the development of care management and disease management programs that meet the needs of our members. * Ensure new and existing programs are implemented as designed and make recommendations for continuous quality improvement. * Manages and participates in departmental projects, workflow processes, policies, and procedures in collaboration with internal and external stakeholders. * Evaluates patient care data to ensure that care is provided in accordance with clinical guidelines and MetroPlusHealth organizational standards. * Develops and maintains professional networks and individual relationships with hospitals, physicians, and other providers to promote continuity and quality of care. * Collaborates with staff and leadership to develop and implement systems that support operations and business goals within identified areas of responsibility. * Uses a collaborative approach with the care management team and utilization management to revise, develop, and implement cost savings methodologies and interventions. * Facilitates communication with providers to ensure continuity of care and coordination between multiple specialists, providers, and vendors. * Participates as an integral part of member interdisciplinary care teams to ensure compliance with Medicare model contract. * Participates in quarterly interdisciplinary rounds with designated virology sites * Recommends and participates in departmental policy and procedure development; and participates in internal and external committee meetings as they relate to care management activities. * Collaborate with Behavioral Health to develop strategies and best practices that lead to desired goals and objectives for members who are co-managed. * Collaborate with Quality Management to address suboptimal performance on HEDIS/QARR indicators and implement performance improvement projects. * Ensures that policies and procedures are developed and enforced in alignment with the standards of patient care and regulatory bodies and that the core components of the care management process are followed. * Ensures Care Management team meets established performance metrics and performance guarantees. * Performs other duties as needed and assigned by the Medical Director relevant to Care Management activities. Minimum Qualifications * Bachelor's degree from an accredited college or university in a healthcare-related field is required. Master's degree from an accredited college or university in Nursing, Social Work or other healthcare related discipline is preferred. * Minimum of 5 years of Case Management experience. * Minimum of 3 years of managerial experience and leadership in a Case Management role within a managed care organization or hospital setting preferred * Knowledge of NCQA's Case Management Accreditation Standards. * Proficiency in Microsoft Office and strong data analytical skills. Licensure and/or Certification Required: * A valid New York State license and current registration to practice as a Registered Nurse (RN), Licensed Mental Health Counselor (LMHC), Licensed Master Social Worker (LMSW), or Licensed Clinical Social Worker (LCSW) is required. * Certified Case Manager (CCM) preferred. Professional Competencies: * Integrity and Trust * Customer Focus * Functional/Technical Skills * Written/Oral Communications