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Department of Social Services (MSH) - Req Number: 2444024
Job Title: Health Home Network Manager
Roles & Responsibilities:
Mount Sinai Health Partners (MSHP) is the management services organization developed to enhance the Health System’s implementation of population health initiatives, that is, programs of care that enhance the patient experience and health status, improve the health of patient populations and reduce utilization and healthcare costs. Population health initiatives particularly focus on preventive care. MSHP provides the infrastructure to support population health initiatives and includes services such as care coordination, information technology, workflow optimization, physician engagement and quality reporting. The Department of Social Work Services takes a leadership role in MSHP Care Management, which is providing in person and telephonic short-term and long-term care management services for a large diverse group of individuals who have a variety of insurances that are part of value based contracts. The goal of MSHP Care Management is to provide standardized care management services to meet patients’ medical and psychosocial needs, increase quality and reduce unnecessary health care costs.
Mount Sinai Health Home (MSHH) is an integral part of Mount Sinai Health Partners (MSHP). MSHH is a NYS Department of Health (DOH) program designed to serve Medicaid/Medicaid Managed Care enrollees who have high-cost and complex chronic conditions. MSHH, a patient-centered program, is a care management service model which aims, through improved care coordination and service integration, to control future health care costs and improve health outcomes for this population. MSHH is has been serving adults since 2013, and the Mount Sinai Health Home serving children was designated in 2016. MSHH care management services are performed by internal social workers and care coordinators, as well as care managers from over 25 care management agencies (CMAs). Serving over 5,000 patients, these care managers are expected to ensure that patients “receive everything necessary to stay healthy, out of the emergency room, and out of the hospital.”
The Network Manager will provide the necessary management, administrative support, and oversight for the various care management organizations under MSHH and help measure and assess their adherence to quality, policy, and other programmatic standards. The Network Manager is a highly visible role with significant opportunities to engage with senior leadership of network partners and across the Mount Sinai Health System. The Network Manager will also interface with key stakeholders from state government and managed care.
• Leads and completes administrative network support activities related to Medicaid Health Home programmatic requirements including: policy, procedure and workflow development; and management of external relations to help ensure operational targets and reporting requirements are met or exceeded.
• Monitors, tracks and ensures network adherence to all state and federal program regulatory, billing, and compliance standards through the Quality Monitoring Program (QMP):
o Develop and facilitate trainings for network providers related to HH practice and procedures to help improve quality and compliance;
o Inform network training strategy based on needs identified
o Conduct chart audits, on site visits, and quality related crosswalks, to help identify opportunities for performance improvement and provide feedback to the CMAs;
o Assist in the development, distribution and follow up of corrective action plans with network providers with substandard performance;
o Monitor and respond to incidents throughout the network (includes incident reports/reviews/follow up)
• Administers regular policy communications, re/training opportunities, Health Home seminar series, and acts as day-to-day point of contact for network policy and procedure (P&P) and quality concerns.
• Promotes positive relationships with Mount Sinai Health Home, Mount Sinai Health Partners, and Mount Sinai Health System, as appropriate, in all external community and government settings.
• Participates in special projects and performs other duties as needed.
• Masters degree highly preferred.
• Demonstrated leadership experience in innovative programs with complex operational and regulatory requirements preferred.
• Strong interest in being part of an innovative initiative to improve the quality and cost of care.
• Able to perform complex analytics; fluency in Microsoft Excel strongly preferred.
• Excellent written and verbal communication; able to summarize analyses in a way that simplifies complex ideas and synthesizes information into insights.