Educational/Enrollment Process Educate and provide assistance to qualified individuals with applying for coverage through the NY State of Health Marketplace in a Qualified Health Plan (QHP) and insurance affordability programs such as Medicaid and Child Health Plus. Assist consumers/applicants with calling the NY State of Health Customer Services Department for assistance

Manager of Behavioral Health Quality (RN, LPN or LMSW/LCSW) Job Ref 106123 Category Behavioral Health Department QUALITY MANAGEMENT Location 50 Water Street, 7th Floor, New York, NY 10004 Job Type Regular Employment Type Full Time Hire In Rate $106,179.00 Salary Range $106,179.00 $116,179.00 Empower. Unite. Care. MetroPlusHealth is committed to empowering New Yorkers by u

MetroPlusHealth is seeking an IT Business Analyst to join our team. We are looking for a professional with experience in healthcare business systems and analysis. The successful applicant will serve as the liaison between the executive/business areas and the IT department of MHP, leveraging the tools and processes developed and managed by the IT department, while analyzin

Health & Wellness Advisor I (Partnership in Care) Job Ref 106294 Category Professional Department PARTNERSHIP IN CARE Location 50 Water Street, 7th Floor, New York, NY 10004 Job Type Regular Employment Type Full Time Hire In Rate $55,323.00 Salary Range $55,323.00 $55,323.00 Empower. Unite. Care. MetroPlusHealth is committed to empowering New Yorkers by uniting communitie

The Behavioral Health UM Care Coordinator provides comprehensive service and support to providers and members as needed. The primary responsibilities include but are not limited to responding to all provider inquiries for Behavioral Health Core and HARP authorizations, documenting such contacts into the tracking clinical system, manage and maintain inbound queues for the

The Customer Services Quality Assurance Analyst (QAA) is responsible for assessing the quality of the performance of our call center representative who deal with our existing and potential customer. The QAA will be responsible for ensuring that our Customer Services Representatives are meeting expectations as detailed in the departmental policies and procedures. This indi

Provide technical administrative support for all network development and contracting activities. The primary focus of the position will be on outreach, recruitment, and contracting of Behavioral Health providers Job Description Research and Prepare provider contracts after credentialing is completed in Contract Lifecycle Management System (CLM). Build and maintain relatio

Medicaid Care Manager Team Lead (RN) Job Ref 98746 Category Utilization Review and Case Management Department CASE MANAGEMENT PROGRAM Location 50 Water Street, 7th Floor, New York, NY 10004 Job Type Regular Employment Type Full Time Salary Range $100,000.00 $110,000.00 Empower. Unite. Care. MetroPlusHealth is committed to empowering New Yorkers by uniting communities thro

Labor and Employee Relations Business Partner Job Ref 106221 Category Human Resources Department HR OPERATIONS Location 50 Water Street, 7th Floor, New York, NY 10004 Job Type Regular Employment Type Full Time Hire In Rate $95,000.00 Salary Range $95,000.00 $105,000.00 Empower. Unite. Care. MetroPlusHealth is committed to empowering New Yorkers by uniting communities thro

Case Management Associate (High Risk OB, Social Determinants of Health) Job Ref 102738 Category Professional Department CASE MANAGEMENT PROGRAM Location 50 Water Street, 7th Floor, New York, NY 10004 Job Type Regular Employment Type Full Time Hire In Rate $50,000.00 Salary Range $50,000.00 $50,000.00 Empower. Unite. Care. MetroPlusHealth is committed to empowering New Yor

The Assessment Nurse is the first person that the potential member/member and family meet from the MLTCP programs. The Assessment Nurse conducts the UAS assessment to determine the level of care needed to support applicants/members in their own homes. The Assessment Nurse completes the UAS assessment tool and makes the determination if an applicant is appropriate for the

The Claims Service Correspondent is responsible for accurate and timely response to written claim inquiries received from providers. This individual provides support regarding the adjudication and adjustment of claims for multiple lines of business. They will work closely with Provider Contracting, Medical Management, Enrollment and Membership department, and Claims Proce

MetroPlus Health is seeking a Business Transformation Lead who will help drive the way we conduct and operate traditional business functions, challenging the status quo and injecting innovative thought leadership to improve operational efficiencies and lead the flawless execution. The Business Transformation Lead will partner with our cross function stakeholders to introd

The Care Management Associate, under the direction of the CMA Supervisor, is responsible for the daily activities of the member case intake functions and associated workflow, as well as for performing other duties associated with the coordination of member care as outlined for the MLTC/PCS Team. Job Description Handles both incoming and outgoing calls on the MLTC/PCS ACD

The primary goal of the Transitions of Care (TOC) Care Manager is to provide care coordination services as members move from one setting to another. Examples of these settings include inpatient facilities, emergency department, rehabilitation facilities, long term care facilities, and certified home health agencies. The goal is to prevent re admissions and reduce avoidabl