Positions and Apply

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.

Responsibilities include:

  • 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

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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.

Responsibilities include:

  • 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.

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