What are the responsibilities and job description for the Administrative Director of Nursing- Medicaid Managed Care position at Good Shepherd Services?

About Us

Good Shepherd Services is a leading multi-service agency with more than 85 programs that serve over 30,000 youth and families each year - and builds on their strengths to help them gain skills for success. At Good Shepherd we respect the dignity and worth of every person and reject intolerance, inequity and injustice in whatever form it may take. Voted one of the top 100 places to work in NYC by Crain's New York, Good Shepherd Services offers a fantastic work environment, a collaborative team dedicated to fulfilling our mission, and an amazing array of benefits. Join our team and help make a difference!

Benefits

Salary : $125,000 / Yr. to $135,000 / Yr.

Benefits / Perks :

Tuition Assistance Program
Monthly MetroCards or travel reimbursement for use of personal vehicle will be provided to staff conducting home visits to families
Generous paid time off (Including 5 Self-Care Days / Floating Holidays, 12 Sick Days, 15 Vacation Days, and 11 Holidays)
Healthcare Plans (Medical, Dental, Vision, and Pet Care)
403(b) Plan (GSS contributes 3% of your salary to your 403(b) plan after 3 years of service, with contributions increasing over time)
Candidates hired in this position will work in person but will have the flexibility to work remotely when program need allows

Overview

Title : Administrative Director of Nursing, Medicaid Manage Care

Reports to : Vice President of Health Services

Location : 337 East 17th Street

Hours : 35 hours, exempt (Please be aware this position requires staff to be onsite. Hybrid may be at leadership and program discretion following probationary period)

Salary : 125k-135k

Job Summary : The Administrative Director of Nursing, Medicaid Manage Care is responsible for the day-to-day operations of the Core Limited Health-Related (CLHRS) and Other Limited Health-Related Services (OLHRS) services as outlined in Article 29I, and the associated Medicaid Manage Care billing, to children / youth in care. Responsible to oversee Article29I (A29I) health services documentation and practices in the provision of care Medicaid Managed Care. The ADON will work closely within the Health Services Department, Vice President of Clinical Practice Implementation, Directors of Nursing, and other leadership in collaboration with A29I and Medicaid Manage Care deliverables. Overall, compliance review of medical necessity for level of Care is established within the 24-hour time frame as required for the CLHS and OLHRS, to initiate billing of care at the Medicaid Per Diem Rate for youth; to provide oversight in the coordination of Medicaid Managed Care Plans (MMCPs) and participant programs for health services. To ensure delivery of services are rendered and eligible to be billed.

Major Duties :

Complete the Health Service and serve as approver for A29I initial and annual Comprehensive Individualized Person-Centered Treatment Plans in collaboration with the EFFC and Residential treatment teams

Meet with the Health Service team regularly to obtain health documentation and perform real time chart reviews for all health-related information and documentation results for culmination and implementation of the treatment plans

Review triage report and pre-placement documents for historical medical information, and current health records through Docushare

Oversee compliance for all Medical and HIPAA consents for appropriate management of care in collaboration with the Director of Nursing for EFFC and Residential

Manages, reviews, and monitors maintenance of youth health records to ensure both internal and external quality assurance standards and timely completion in accordance with agency and regulatory entities; perform internal medical case review audits for quality care and best practices in pediatric / adolescent health

Provides initial and continuous training to all new and existing health services staff regarding care management documentation in accordance with Article 29I

Collects, analyzes, and reports data in accordance with Medicaid Manage Care health case requirements.

Will supervise Medicaid Managed Care Liaisons (MMCL); work collaboratively with Nurse Care Managers

Develop linkages and agreements with external community providers participating in Medicaid Manage Care Plans (MMCPs)

Complete and conduct monthly and random reports to monitor the efficiency of billing and communicate with the MMCPs and program to address eligibility issues and continuity of eligibility benefits to youth in EFFC and Residential

Stay updated in ACS, OCFS and MMCPs health policy, compliance, and procedural practices

Works collaboratively with all teams throughout agency programs

Completes special projects and qualitative reports as needed by the Vice President of Health Services to support the provision of Core Health-Related services, Article 29I guidance and MMCPs

Other duties as assigned.

Qualifications :

Registered Professional Nurse licensed to practice in New York, BSN required, Master in Nursing or Allied Health related field preferred

4-5 years of administrative, clinical, or supervisory / managerial experience in health care

Demonstrates strong leadership and management skills to ensure progressive, positive development of Medicaid Care Management health practices.

Knowledge of best practice working with children and families in health, preventive and wellness care

Expertise, and Knowledge of the child welfare system, foster care healthcare requirements, the complex health care needs of foster care population, and Medicaid Managed Care policies and operations.

Experience assisting health teams providing best practices in medical / nursing care management and qualitative review

Experience using Microsoft Outlook, Excel and electronic health care systems, Evolv, Connections for the oversight of care, review, management of documents and data analysis

Experience reviewing and developing health policies and practices

Excellent accountability, writing, communication, and organizational skills

Compassion for serving children and families in underserved communities.

Ability to travel to program offices when needed.

Proven decisiveness, motivational, and developmental skills; management abilities, including meeting deadlines, ensuring compliance with agency policies and procedures, and overseeing complete and timely maintenance of agency records, in accordance with contractual requirements.

Additional Information

Good Shepherd Services is an equal opportunity employer that is proudly committed to becoming an anti-racist and multicultural organization that stands up for justice and equity. We welcome prospective employees from diverse backgrounds, for administrative support and direct service and leadership roles, who will join us on that journey, uphold our values and approach, and believe in our mission. Additionally, we aim to have a racially representative leadership and workforce that is reflective of the communities we work in partnership with.

Good Shepherd Services is committed to providing an inclusive and welcoming environment for all members of our staff, participants, volunteers, subcontractors, and vendors. We do not discriminate on the basis of race, color, religion (creed), gender, gender expression, age, national origin (ancestry), disability, marital status, sexual orientation, or military status, in any of our activities or operations. These activities include, but are not limited to, hiring and termination of staff, selection of volunteers and vendors, and provision of services.

We are committed to providing a workplace that is accessible and accommodating to employees with disabilities. As part of our commitment to providing a barrier-free recruitment and selection process, we will provide reasonable accommodations upon request for candidates with disabilities. If you require any accommodations to participate in the hiring process, please inform us of your needs in advance. We value diversity and inclusivity in our workplace and encourage applicants of all abilities to apply.

Salary : $125,000 - $135,000

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