Identify prospective enrollees and determine eligibility for participation in MetroPlusHealth's Medicare product. Understand and apply all policies and procedure pertaining to Disclosures and provisions of the MetroPlusHealth Medicare product. Enrollment and disenrollment. Conduct home visits, and personalized appointments as needed to complete the enrollment process. Mar

Reporting to the Vice President of Provider Network Operations, the Director of Provider Engagement will lead the Provider Engagement team and have overall accountability to develop and maximize improved alignment, driving high performance and provide world class engagement experience with identified key providers. By leading market level projects and strategies for provi

Director of Provider Data Integrity and Program Management Job Ref 105326 Category Professional Department Provider Network Operations Location 50 Water Street, 7th Floor, New York, NY 10004 Job Type Regular Employment Type Full Time Hire In Rate $145,000.00 Salary Range $145,000.00 $155,000.00 Empower. Unite. Care. MetroPlusHealth is committed to empowering New Yorkers b

Collaborate with the internal and external teams to develop and maintain the MLTC/MAP disenrollment operational processes and procedures. Coordinate the MLTC/MAP enrollment and disenrollment workflow. Troubleshoot cases which require further investigation by Marketing or Maximus to complete the eligibility and enrollment process Provide feedback regarding eligibility or e

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

Manager of Call Center Quality and Compliance Job Ref 104050 Category Call Center Department CALL CENTER Location 50 Water Street, 7th Floor, New York, NY 10004 Job Type Regular Employment Type Full Time Hire In Rate $75,000.00 Salary Range $75,000.00 $85,000.00 Empower. Unite. Care. MetroPlusHealth is committed to empowering New Yorkers by uniting communities through car

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 Specialis

Collaborates with IT Security management in the development of enterprise Security assessment tools and policy and procedures. Assesses information risk and facilitates remediation of identified vulnerabilities with the organization, systems and applications and vendors. Reports on findings and recommendations for corrective action. Job Description Collaborates with IT Se

The Care Manager under the direction of the Vice President of Clinical Services, is primarily responsible for managing both simple and complex medical cases to achieve high quality patient care outcomes and minimize unnecessary medical expenses, through the coordination of services, both outpatient and inpatient. The Care Manager will assist the provider in directing care

The Care Management Associate I (CMA), under the direction of the Vice President of Clinical Services, is responsible for the daily activities of member case intake, processing functions, and associated workflow, as well as for performing other duties associated with the coordination of member care as outlined and/or assigned by their manager. Job Description Receive serv

Identify prospective enrollees and determine eligibility for participation in MetroPlusHealth's Medicare product. Understand and apply all policies and procedure pertaining to Disclosures and provisions of the MetroPlusHealth Medicare product. Enrollment and disenrollment. Conduct home visits, and personalized appointments as needed to complete the enrollment process. Mar

Manager of Long Term Services and Supports (Case Management) (RN) Job Ref 106332 Category Managed Long Term Care Department CASE MANAGEMENT PROGRAM Location 50 Water Street, 7th Floor, New York, NY 10004 Job Type Regular Employment Type Full Time Hire In Rate $130,000.00 Salary Range $130,000.00 $140,000.00 Empower. Unite. Care. MetroPlusHealth is committed to empowering

HARP Care Manager (with additional $10,000 field differential) Job Ref 106317 Category Behavioral Health Department BEHAVIORAL HEALTH HARP Location 50 Water Street, 7th Floor, New York, NY 10004 Job Type Regular Employment Type Full Time Hire In Rate $83,000.00 Salary Range $83,000.00 $83,000.00 Empower. Unite. Care. MetroPlusHealth is committed to empowering New Yorkers

Information Technology Department has an immediate opening for an EDI Software Developer on the EDI development team. The successful candidate will be responsible for BizTalk administration and BizTalk Application development. Job Description Develop, maintain, and administer the company's BizTalk EDI environment. Design, develop, and maintain BizTalk applications and EDI

Manager of Customer Success Concierge Services Job Ref 106345 Category Member Services Department MHP CUSTOMER SUCCESS Location 50 Water Street, 7th Floor, New York, NY 10004 Job Type Regular Employment Type Full Time Hire In Rate $75,000.00 Salary Range $75,000.00 $85,000.00 Empower. Unite. Care. MetroPlusHealth is committed to empowering New Yorkers by uniting communiti