Administrative Director of Nursing- Medicaid Managed Care
US-NY-New York
External
Req #: 7837
Type: Regular Full-Time
Overview: Title: Administrative Director of Nursing, Medicaid Manage Care Reports to: Vice President of Health Services Location: 337 East 17th Street Hours: 35 hours, exempt (Please be aware this position requires staff to be onsite. Hybrid may be at leadership and program discretion following probationary period) Salary: 125k-135k Job Summary: The Administrative Director of Nursing, Medicaid Manage Care is responsible for the day-to-day operations of the Core Limited Health-Related (CLHRS) and Other Limited Health-Related Services (OLHRS) services as outlined in Article 29I, and the associated Medicaid Manage Care billing, to children/youth in care. Responsible to oversee Article29I (A29I) health services documentation and practices in the provision of care Medicaid Managed Care. The ADON will work closely within the Health Services Department, Vice President of Clinical Practice Implementation, Directors of Nursing, and other leadership in collaboration with A29I and Medicaid Manage Care deliverables. Overall, compliance review of medical necessity for level of Care is established within the 24-hour time frame as required for the CLHS and OLHRS, to initiate billing of care at the Medicaid Per Diem Rate for youth; to provide oversight in the coordination of Medicaid Managed Care Plans (MMCPs) and participant programs for health services. To ensure delivery of services are rendered and eligible to be billed. Major Duties: * Complete the Health Service and serve as approver for A29I initial and annual Comprehensive Individualized Person-Centered Treatment Plans in collaboration with the EFFC and Residential treatment teams * Meet with the Health Service team regularly to obtain health documentation and perform real time chart reviews for all health-related information and documentation results for culmination and implementation of the treatment plans * Review triage report and pre-placement documents for historical medical information, and current health records through Docushare * Oversee compliance for all Medical and HIPAA consents for appropriate management of care in collaboration with the Director of Nursing for EFFC and Residential * Manages, reviews, and monitors maintenance of youth health records to ensure both internal and external quality assurance standards and timely completion in accordance with agency and regulatory entities; perform internal medical case review audits for quality care and best practices in pediatric/adolescent health * Provides initial and continuous training to all new and existing health services staff regarding care management documentation in accordance with Article 29I * Collects, analyzes, and reports data in accordance with Medicaid Manage Care health case requirements. * Will supervise Medicaid Managed Care Liaisons (MMCL); work collaboratively with Nurse Care Managers * Develop linkages and agreements with external community providers participating in Medicaid Manage Care Plans (MMCPs) * Complete and conduct monthly and random reports to monitor the efficiency of billing and communicate with the MMCPs and program to address eligibility issues and continuity of eligibility benefits to youth in EFFC and Residential * Stay updated in ACS, OCFS and MMCPs health policy, compliance, and procedural practices * Works collaboratively with all teams throughout agency programs * Completes special projects and qualitative reports as needed by the Vice President of Health Services to support the provision of Core Health-Related services, Article 29I guidance and MMCPs * Other duties as assigned. Qualifications: * Registered Professional Nurse licensed to practice in New York, BSN required, Master in Nursing or Allied Health related field preferred * 4-5 years of administrative, clinical, or supervisory/managerial experience in health care * Demonstrates strong leadership and management skills to ensure progressive, positive development of Medicaid Care Management health practices. * Knowledge of best practice working with children and families in health, preventive and wellness care * Expertise, and Knowledge of the child welfare system, foster care healthcare requirements, the complex health care needs of foster care population, and Medicaid Managed Care policies and operations. * Experience assisting health teams providing best practices in medical/nursing care management and qualitative review * Experience using Microsoft Outlook, Excel and electronic health care systems, Evolv, Connections for the oversight of care, review, management of documents and data analysis * Experience reviewing and developing health policies and practices * Excellent accountability, writing, communication, and organizational skills * Compassion for serving children and families in underserved communities. * Ability to travel to program offices when needed. * Proven decisiveness, motivational, and developmental skills; management abilities, including meeting deadlines, ensuring compliance with agency policies and procedures, and overseeing complete and timely maintenance of agency records, in accordance with contractual requirements. Qualifications: Good Shepherd Services is an equal opportunity employer that is proudly committed to becoming an anti-racist and multicultural organization that stands up for justice and equity. We welcome prospective employees from diverse backgrounds, for administrative support and direct service and leadership roles, who will join us on that journey, uphold our values and approach, and believe in our mission. Additionally, we aim to have a racially representative leadership and workforce that is reflective of the communities we work in partnership with. Good Shepherd Services is committed to providing an inclusive and welcoming environment for all members of our staff, participants, volunteers, subcontractors, and vendors. We do not discriminate on the basis of race, color, religion (creed), gender, gender expression, age, national origin (ancestry), disability, marital status, sexual orientation, or military status, in any of our activities or operations. These activities include, but are not limited to, hiring and termination of staff, selection of volunteers and vendors, and provision of services. We are committed to providing a workplace that is accessible and accommodating to employees with disabilities. As part of our commitment to providing a barrier-free recruitment and selection process, we will provide reasonable accommodations upon request for candidates with disabilities. If you require any accommodations to participate in the hiring process, please inform us of your needs in advance. We value diversity and inclusivity in our workplace and encourage applicants of all abilities to apply.
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