Director of Integrated Case Management for Medicare
Company: MetroPlusHealth
Location: New York City
Posted on: February 2, 2026
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Job Description:
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
MetroPlus Health 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,
MetroPlus Health 's network includes over 27,000 primary care
providers, specialists and participating clinics. For more than 40
years, MetroPlus Health 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 HH 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
Keywords: MetroPlusHealth, Camden , Director of Integrated Case Management for Medicare, Healthcare , New York City, New Jersey
