Medicaid Eligibility Supervisor
250 West 57th Street
GuildNet, is an established long-term Medicaid Managed Care Plan (MLTC), Special Needs Plan (SNP) and Fully Integrated Dual Advantage Plan (FIDA) for the visually impaired and/or blind population throughout the New York City boroughs. Reporting to the Senior Vice President, Intake, you will serve as an eligibility specialist and play an integral role in the daily operations of the Medicaid Eligibility staff, including supervising, providing guidance, expertise and instruction to all team members.
Successful candidate will have at least 1 year experience working with Medicaid Entitlement eligibility, 1-2 years of supervisory experience, and the ability to effectively work with adult and geriatric populations with special needs and complex social issues. Demonstrated empathy towards enrollees and significant others will be expected, as will the ability to transport oneself to members’ homes. Solid leadership, instructional, oral/written communication, interpersonal, analytical and PC skills are all essential. Bachelor’s degree preferred.
- Overseeing the Medicaid Eligibility Department, including delegating tasks to staff
- Assisting members in the determination of Medicaid eligibility and other entitlements
- Providing home visits as needed to assist with completion of Medicaid applications and certifications
- Collaborating with HRA in the preparation and submittal of documentation for initial Medicaid applications and re-certifications
- Managing the tracking of member’s Enrollment form; outcome of entitlement submission and re-certification
- Assisting enrollees with scheduling and/or attending Medicaid Fair Hearings to resolve discrepancies on an as needed basis
- Serving as a mentor and assigning tasks to the Eligibility Specialist
- Remaining current with HRA regulatory changes and communicating updates in GUILDNET policy and procedures to HRA
- Orienting new employees to the Medicaid eligibility process
- Participating in enrollee’s team meetings and/or plan of care reviews
Registered Nurse – Population Health Management Specialist
New York, NY
GuildNet, is an established long-term Medicaid Managed Care Plan (MLTC), Special Needs Plan (SNP) and Fully Integrated Dual Advantage Plan (FIDA) for the visually impaired and/or blind population throughout the New York City boroughs.
Reporting to the Assistant Vice President, Population Health Management, you will oversee the development, planning and education of GuildNet members in relation to their overall wellness/preventative and chronic care, while promoting healthy behaviors and life styles for all GuildNet members.
- Reaching out to members referred to the Population Health Management Program (PHM) to assess knowledge and understanding of overall wellness and expected behavior changes
- Reviewing high risk cases identified through predictive risk modeling tools
- Working collaboratively with members, caregivers, GN Care Managers and Physicians to coordinate appropriate care and self-management education pertaining to overall health
- Recommending referrals to specialists and related health services as needed
- Encouraging members to adopt habits that enable them to have a better quality of life
- Providing preventative care in member’s home, including Fundus Camera eye screening and ensuring members get their Flu vaccines
- Ensuring members are following standards of care
- Reviewing and analyzing quality reports
- Developing interventions and following up with non-adherent members to close gaps in care
- Reviewing hospitalization reports and referring members to telehealth and other clinical programs
- Analyzing program metrics and developing action plans to improve HEDIS, STAR ratings and other clinical quality projects as needed
- Tracking and trending operational and clinical outcomes for PHM programs
- Planning and coordinating disease management/wellness programs/activities to educate clinical staff, members, families, caregivers and the community
- Assisting in the development and conducting on-site health related wellness seminars
- Participating in special studies related to quality improvement activities such as IPRO, CCIP, QIP and HEDIS
- Handling other related functions as necessary
To qualify, you must have a current NYS RN License, preferably with a BSN or Bachelor’s Degree in a health-related field, and prior clinical experience in geriatrics, homecare, long-term care, and/or managed long-term care. Knowledge of principles of health education and behavior change, strong assessment/teaching skills, and the ability to develop and implement programs to change health behaviors will be expected, as will demonstrated knowledge of basic health and nationally recognized standards of care guidelines for wellness and chronic disease management. The ability to interpret clinical documentation, and excellent oral/written communication, interpersonal, analytical and problem-solving skills are all essential.Apply
Executive Assistant to Executive Vice President and COO
In this highly visible role, you will work independently to support the COO with a variety of complex administrative and operational functions, maintain confidential files/records, and serve as a liaison between the COO and staff, departments, Board Members, and the public.
Managing the daily operations of the COO
Opening, sorting, distributing and acknowledging correspondence
Receiving and screening calls and answering inquiries
Making arrangements for Committee and Board meetings, including preparation of Agenda, editing and compilation of pertinent materials for distribution to Board Members, staff and the media
Coordinating meetings, conferences, & speaking engagements
To qualify, you must have Associates degree or equivalent business school experience with a minimum of 6 years of executive level AA experience. Excellent analytical, oral/written communication, interpersonal, multi-tasking and organizational skills will be expected, as well as proficiency with Microsoft Office.Apply
GUILDNET our rapidly growing innovative long-term managed care program for visually impaired/blind population throughout the New York City region, is now offering excellent career and growth opportunities. We are currently looking for candidates to fill the role of Reassessment RN. In this position, you will reassess members and review plans of care every 180 days or perform interim assessments as requested. Positions available in the five boroughs and Long Island.
- Associate Degree in Nursing, BSN preferred
- 2 years experience in Managed Care Setting
- Ability to work independently
- Excellent organizational, verbal and written skills
- Trained and knowledgeable in the UAS-NY Assessment System (Assessor level and Trust Level 3 preferred)
- Computer literacy
- Bilingual Chinese, Russian, Spanish preferred
You will identify health care needs requiring case assessment, assess potential members in their homes, and orient potential members and involved team to needed services.
- 2 years experience in case management and/or home care preferred
- Excellent assessment, verbal and written communication skills required
- BSN/relevant baccalaureate degree preferred
Nurse Case Manager
GUILDNET our rapidly growing innovative long-term managed care program for the visually impaired/blind population throughout the New York City region, is now offering excellent career and growth opportunities. We are currently looking for candidates with a successful track record of thriving in a fast paced and challenging Managed Care and/or Home Care environment, to fill the role of Nurse Case Manager. In this position you will provide telephonic case management of long-term health care services allowing plan members to remain in the community by collaborating with health care providers and developing personalized plans of care. Positions available in NYC, Brooklyn, White Plains and Melville.
- BSN or relevant Baccalaureate degree preferred
- Candidate must have a valid NYS RN license
- 2 years experience in Case Management and/or Home Care preferred
- Computer literacy
- Bi-lingual, Spanish, Russian, Chinese Preferred