Lead Complex Care Manager - Emblem Health

• Support EmblemHealth population health complex care management initiatives by providing care management services
engaging with the most complex individuals enrolled in care management programs.
• Provide oversight to a multidisciplinary care team responsible for a population of health plan enrollees in a discrete "case
panel" or care pod.
• Engage with the most complex members of the health plan with the goal of improving health care outcomes and appropriate
and timely utilization of services.
• Serve as the "quarterback" or "leader" of a care pod (care team) who will assess and triage members to the most appropriate
level of support needed.

Principal Accountabilities

• Assess and evaluate needs of our most complex members, coordinating care utilizing the most appropriate resources
to support member needs. This includes member and family as appropriate.
• Engage actively with the member PCP /designee
• Engage with the member in support of their treatment team to identify and establish attainable goals that positively
impact clinical, financial, and quality of life outcomes for member
• Act as the "triage" lead for the care team to identify members with changing conditions in the case panel supporting
navigation to the most appropriate individuals
• Assess the needs of members in the case panel and align them with the appropriate member of the care team
(disease manager, behavioral healthcare manager, pharmacist, social worker)
• Monitor care team performance to ensure that members of the case panel are engaged in a timely fashion and that
performance metrics (admits/K, ER utilization, etc.) meet or exceed established thresholds
• Provide ongoing monitoring, evaluation, support and guidance to the coordination of the member's health care
• Serve as an informal leader of the team with the goal of maintaining team performance and high morale.

Education, Training, Licenses, Certifications

• Bachelor's degree from an accredited college or university.
• Active, unrestricted RN license.
• CCM certification required. Consideration given to certification candidates, but certification must be completed within 12
months of hire date as a condition of continued employment.

Relevant Work Experience, Knowledge, Skills, and Abilities

• 5 - 8+ years of clinical experience. (R)
• Staff and process management experience; ability to manage staff performance. (R)
• Advanced knowledge of complex medical conditions to properly address/escalate issues. (R)
• Ability to identify, implement, and ensure compliance with established metrics and procedures. (R)
• Prior health plan experience. (P)
• For Albany location(s): must be physically present at specific site locations at least 3 - 4+ times/month. (R)
• Excellent communication skills (verbal, written, presentation, interpersonal) with all types/levels of audiences; and the ability
to effectively engage practitioners and other external stakeholders. (R)
• Proficient with MS Office (Word, Excel, PowerPoint, Outlook, Teams, etc.). (R)
• Ability to build relationships both internally and externally while delivering excellent customer service. (R)
• Experience in compiling and analyzing data. (R)
• Experience with data retrieval and statistics. (P)
• Must be detail-oriented with strong organizational skills, including the ability to coordinate workflow. (R)
• Knowledge of / familiarity with community resources and social service resources to assist patients with social needs. (P)
• Demonstrated knowledge with the regulatory requirements of DOH, CMS, NCQA. (R)

Additional Information

• Requisition ID: 1000000742_02
• Hiring Range: $88,000-$120,000