Manager - Care Management Business Operations

Position Overview

As Mount Sinai grows, so does our legacy in high-quality health care. Since 1949, Mount Sinai Medical Center has remained committed to providing access to its diverse community by offering the latest in advanced medicine, technology, and comfort across multiple facilities. Our hardworking community of more than 4,000 dedicated employees fosters an environment of care, compassion, and clinical excellence. Department: CC017410 Care Management invites healthcare professionals to join our innovative team and help us continue our mission of delivering outstanding care.

Key Responsibilities

• Develops and maintains effective relationships with payors, including contact as required with representatives to ensure accomplishment of utilization management activities.
• Oversees the management of observation cases, both concurrently and retrospectively, as needed.
• Supports the clinical denial management process by ensuring that all denials related to medical necessity and delays in service/discharge are identified, addressed promptly, and documented appropriately.
• Ensures concurrent flow of information between the Care Management Department and other MSMC departments responsible for managed care contracts and patient accounts/billing.
• Participates with other MSMC entities involved in the denial management process to ensure that denials and appeals are tracked, trended, and reported to the Director regularly.
• Familiarizes with payor policies and appeals processes to ensure appeals are completed and followed up on in a timely manner.
• Generates and interprets reports/conducts audits to ensure compliance with documentation and to identify opportunities for improvement, following up as needed.
• Collaborates with other departments to generate outcome data to measure and trend performance indicators identified in the Utilization/Medical Management Plan.
• Manages data collection, aggregation, and dissemination across the continuum, including clinical, financial, and operational performance reviews.
• Participates in hiring, reviews, discipline, and grievance handling to ensure optimal individual and team performance.
• Engages in staff development activities by interacting with the director, customers, and others to continuously improve departmental competency and effectiveness.
• Identifies and addresses skills or behaviors requiring improvement, both individually and department-wide.
• Provides coaching as needed to optimize performance, ensuring safe, satisfactory patient care and optimal customer service.
• Supports the Director in developing the department’s operational budget, analyzing costs and providing justifications for budget variances.
• Provides daily oversight and management to payor teams, ensuring all functions of the staff are accomplished.
• Engages in self-development across clinical, professional, and managerial areas, including commitment to leadership development curriculum.
• Adheres to hospital and departmental standards, policies, and procedures.
• Promotes a service orientation in the performance of position duties and interactions with patients, hospital staff, and visitors.

Required Qualifications

• Education: Bachelor's Degree
• Experience Required: 5 years management experience required.

Benefits & Perks

• Health benefits
• Life insurance
• Long-term disability coverage
• Healthcare spending accounts
• Retirement plan
• Paid time off
• Pet Insurance
• Tuition reimbursement
• Employee assistance program
• Wellness program
• On-site housing for select positions and more!