Medicaid Care Manager Team Lead Registered Nurse
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 direction of the
Director of Medicaid, the Medicaid Care Manager Team Lead ensures
that staff adhere to the Medicaid contractual requirements,
policies and procedures, and workflows established to manage the
vulnerable Medicaid population. The Medicaid Care Manager Team Lead
manages the daily activities of the Medicaid team (Care Managers
and Care Management Associates) to ensure quality outcomes in the
delivery of member-centered case management including reduction in
emergency room visits and hospital admissions, improved member
satisfaction, improved member health, and cost effectiveness. Work
Shifts 9:00 A.M – 5:00 P.M Duties & Responsibilities Provide
clinical guidance and supervision to assigned Care Managers and
clinical support staff to promote efficient and effective delivery
of care management services Supervise day to day activities to make
certain that case management services are provided in accordance
with clinical guidelines, established processed and MetroPlusHealth
organizational standards. Supervise the entire care management
workflow including case referrals, assignments, interventions and
goal setting, follow-up/follow-through activities, documentations,
and escalations. Ensure care management activities are conducted in
a safe, efficient, and effective manner to promote continuity and
quality of care. Review, develop and modify day to day workflows to
ensure timely follow up. Perform ongoing quality review of cases to
ensure accuracy and compliance. Evaluate and document staff
performance; coach staff to improve both quality and quantity of
skills attaining optimal performances. Utilize data to track, trend
and report productivity and outcome measures, work with the
management team to implement necessary improvement strategies.
Coordinate Interdisciplinary Care Team rounds with providers, care
managers and care management associates, this include scheduling
meetings, identifying members for presentation, and ensuring
completion and documentation of follow up activities. Collaborate
Behavioral Health to develop strategies and best practices that
lead to desired goals and objectives for members who are
co-managed. Use expert verbal and non-verbal communication skills
to motivate and gain co-operation of members and their caregivers.
Resolve issues and mitigate conflict encountered during daily
operations, appropriately escalate issues to the Director of
Medicaid Identify and report potential risk, operational
opportunities, and barriers encountered. Conduct monthly audits for
the purpose of departmental/organizational reporting and providing
formal feedback to case management staff. Create and submit
operational weekly/monthly/quarterly reports. Work with the
leadership team to develop and implement ongoing training and
development efforts. Actively participate in staff training and
meetings. Encourage regular communication and inform staff of
relevant departmental and organizational updates. Develop and
maintain collaborative relationships with clinical providers,
facility staff and community resources. Ensure staff comply with
orientation requirements, annual and other mandatory trainings,
organizational and departmental policies, and procedures. Perform
other duties as assigned by Director. Minimum Qualifications
Bachelor's Degree required, Master’s in nursing preferred. A
minimum of 5 years of Care Management experience in a health care
and/or Managed Care setting required. Minimum of 2 years
managerial/leadership experience in a Managed Care and/or
healthcare setting required. Proficiency with computers navigating
in multiple systems and web-based applications. Must know how to
use Microsoft Office applications including Word, Excel, and
PowerPoint and Outlook. Ability to proficiently read and interpret
medical records, claims data, pharmacy and lab reports, and
prescriptions 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).
Integrity and Trust Customer Focus Functional/Technical Skills
Confident, autonomous, solution driven, detail oriented,
nonjudgmental, diplomatic, resourceful, intuitive, dedicated,
resilient and proactive. Strong verbal and written communication
skills including motivational coaching, influencing, and
negotiation abilities. Holds themselves to high standards of
excellence Time management and organizational skills. Strong
problem-solving skills. Ability to prioritize and manage changing
priorities under pressure. Ability to work closely with member and
caregiver. Ability to form effective working relationships with a
wide range of individuals. MPH50 LI-Hybrid 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
Keywords: MetroPlusHealth, New York , Medicaid Care Manager Team Lead Registered Nurse, Healthcare , New York City, New York
