Managed Care

Hours: M-F 9:00am-5:00pm - hybrid (primarily remote but must be in the office as need) 

Hourly Rate/Salary: 190k-207k 

Job Summary: 

We are currently working with a well-established health plan based out of NYC currently seeking a Senior Director of Regulatory Affairs to join their team. Seeking strong regulatory leaders to lead the kickoff all regulatory implementations and report directly into the CCO who is great. 

As a Senior Director of Regulatory Affairs, you will manage a team of regulatory professionals who analyze new regulatory requirements, work closely with the business to understand the impact and obligations of those requirements, and support the business in understanding the evolving regulatory landscape. With wide latitude for individual initiative and decision making, the Senior Director of Regulatory Affairs is responsible for providing leadership and oversight of the Regulatory Affairs unit relating to all products offered by the organization, as well as leading other projects assigned by Executive Leadership.

Hours: M-F 9:00am-5:00pm - Remote after hybrid (work from home / onsite in New York, NY) training 

Hourly Rate/Salary: 77k-92k + bonus

 Job Summary: 

A large managed care healthcare organization with a strong reputation in NY is currently seeking Social Work Care Managers to join their team.

Reporting to the Supervisor of Care Management this position will provide telephonic and virtual assessments of members' medical, psychosocial, physical and spiritual needs. Develops, implements and monitors care plan, ensures continuity of care and monitors member's chronic care benefit.

The Care Manager (LCSW/LMSW) will:

• Provide telephonic and virtual assessments of members' medical, psychosocial, physical and spiritual needs

• Develop, implement, and monitor care plans

• Ensure continuity of care and monitor member's chronic care benefits

• Perform other duties, as needed

Hours: M-F 9:00am-5:00pm - hybrid 

Hourly Rate/Salary: 115k-120k

Job Summary: 

A Managed Care Plan in Manhattan is looking for a Manager of Provider Network Operations to join their growing team. 

The Manager of Provider Operations will: 

• Develop metrics and implement plans to execute ongoing network development 

• Manage the provider application and contract process to ensure that applications forwarded to credentials are complete

• Develop metrics and implement plans to execute ongoing network development to manage network deficiencies

• Manage the provider application/contract process and ensure that applications forwarded to credentials are complete

• Make site visits to provide education to existing and targeted providers

• Other duties, as needed 

Hours: M-F 9:00am-5:00pm

Hourly Rate/Salary: 74k-94k

Job Summary: 

A Medicaid Managed Care Plan in NY is seeking a Manager of Behavioral Health Operations to support the integrated care and behavioral health services team.

The Manager for Behavioral Operations will:

• Serve as the behavioral health lead for the management of coordination and implementation of care managmenet systems
• Partner with leadership to develop and document departmental workflows and related training materials
• Serve as team lead to collaborate on compliance/regulatory and quality matters
• Provide support and/or coordination for various audits