109 Best clinical reviewer Jobs in Newark, New Jersey (November 2025)

MetroPlusHealth

MLTC Care Manager Team Lead

30 days ago

New York

Job Description 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. Under the supervision of the Director of Long Term Care Clinical Programs, the MLTC Care Manager Team Lead is responsible for the day-to-day supervision of a team of care managers within the MLTC department as they strive to keep our members safe and thriving at home. The Care Manager (CM) Team Lead provides comprehensive support and guidance on processes/workflows, identifies training needs, tracks and coaches on productivity, and ensures that high-quality care management is delivered through call and chart audits. This position also conducts new hire onboarding and continued training for all clinical MLTC/MAP staff, participates and interacts with all staff in a supportive role to ensure effective daily operations, and enhances communication and processes across the clinical and non-clinical areas of the department and between other departments. The position also oversees care management to members in long-term care and utilization management of MLTC and personal care services (PCS) for Medicaid managed care. Work Shifts 9:00AM-5:00PM Duties & Responsibilities • Provides guidance to the CMs within the MLTC Department offering care management to members in several lines of business, particularly as it pertains to new processes and workflows which support program operations., • Oversees utilization management of MLTC and PCS, including ensuring compliance with correct, timely review of cases and member/provider communication., • Oversees daily monitoring of staff productivity and tracking of compliance with monthly member outreach calls and annual comprehensive, person-centered service plans., • Oversees care coordination of members residing in and transitioning from skilled nursing facilities, and, in tandem with other MLTC colleagues, optimize the relationship with the nursing home staff to ensure open and productive collaboration., • Promotes and facilitates a collaborative, multidisciplinary approach, supporting MLTC effective and coordinated care operations amongst disciplines/teams., • Oversees clinical program training/retraining and creation and updating of departmental training tools and resources to support the delivery of high quality, efficient care management., • Serves as a subject matter expert and training expert for Clinical Care Management processes and protocols in MetroPlusHealth Systems such as Care Connect, DCMS, Cisco, and all other programs which support MLTC operations., • Oversees and monitors Care Managers’ ACD activity and reporting., • Conducts quality reviews of recorded calls and audits care management documentation, then provides direct feedback and coaching to staff on findings., • Works collaboratively with MLTC management team to ensure program goals, projects and initiatives are implemented following departmental workflows and policy standards., • Works with the team to meet goals for performance improvement projects related to preventing falls and hospitalizations as well as initiatives to improve preventative care and meet other critical quality metrics among members in all lines of business., • Supports Care Management staff as needed when management is in meetings and/or working on other program initiatives, • All other duties or actions as required under the direction of the MLTC management teamMinimum Qualifications, • Bachelor’s degree from an accredited college or university in Nursing or related health care field required; BSN preferred., • 3-5 years of experience required in Care Management and/or Managed Care – Medicaid/MLTC/MAP., • Knowledge of MLTC program requirements required., • Knowledge of long-term care settings., • Experience as a user/reviewer of the UAS tool., • Proficiency with healthcare terminology such as ICD-10 codes, medical abbreviations., • Knowledge of utilization management processes; experience serving as a utilization management reviewer preferred., • Integrity and Trust, • Customer Service Focus, • Knowledge and expertise of computer systems, with proficiency in Microsoft, • office products, • Excellent communications, written and analytical skills, • Strong organizational skills required., • Microsoft Excel skills with the ability to edit, search, sort/filter, format/use styles, create tables, calculate data using functions and formulas and create/use PivotTables for analyzing data

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