Director of Integrated Case Management for Medicare
Company: MetroPlusHealth
Location: New York City
Posted on: January 15, 2026
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Job Description:
Job Description 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, New York , Director of Integrated Case Management for Medicare, Healthcare , New York City, New York
