Children's Care Manager (Registered Nurse) Job Ref 106940 Category Utilization Review and Case Management Department MHP CHILDRENS PROGRAM Location 50 Water Street, 7th Floor, New York, NY 10004 Job Type Regular Employment Type Full Time Salary Range $96,682.00 $96,682.00 Empower. Unite. Care. MetroPlusHealth is committed to empowering New Yorkers by uniting communities t

Creative Services Communications Manager Job Ref 106819 Category Marketing Department TELECOMMUNICATIONS Location 50 Water Street, 7th Floor, New York, NY 10004 Job Type Regular Employment Type Full Time Hire In Rate $95,000.00 Salary Range $95,000.00 $105,000.00 Empower. Unite. Care. MetroPlusHealth is committed to empowering New Yorkers by uniting communities through ca

The BH Care Manager develops, facilitates, and communicates a plan of care in partnership with the member, their assigned Health Home, primary caregiver, the primary and attending physicians, and various Behavioral Health and/or substance use disorder providers. This position collaborates with the aforementioned parties to assess, plan, facilitate, and advocate for option

Salesforce Marketing Cloud Campaign Manager Job Ref 106787 Category Marketing Department MARKETING ADMINISTRATION MHP Location 50 Water Street, 7th Floor, New York, NY 10004 Job Type Regular Employment Type Full Time Hire In Rate $62,941.00 Salary Range $62,941.00 $120,000.00 Empower. Unite. Care. MetroPlusHealth is committed to empowering New Yorkers by uniting communiti

As a Claims Adjustment Specialist I, this individual will be responsible for analyzing standard to complex post paid healthcare claims that require in depth research to determine accuracy and mitigate payment errors. The Claims Adjustment Specialist I will also be responsible for adjusting medical claims that result in overpayment or underpayment due to claim processing s

Vice President of Program Management Job Ref 104144 Category Professional Department MHP PMO Location 50 Water Street, 7th Floor, New York, NY 10004 Job Type Regular Employment Type Full Time Hire In Rate $200,000.00 Salary Range $200,000.00 $226,000.00 Empower. Unite. Care. MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We bel

The Claims Supervisor is responsible for the daily oversight of claims processes including but not limited to the inquiry and resolution process, adjudication process, user acceptance testing and quality assurance, training, and reporting. In addition, the position assists the claims manager with claims related queue management (i.e. claims, inquiries, refunds, adjudicati

The Inpatient/Outpatient Coder is responsible for conducting coding audits and education for providers with greatest opportunity for improvement. This individual will ensure medical diagnosis and procedure codes submitted on provider claims are accurate. In addition, this person will review medical records for physician documentation, clinical evidence that supports the d

The Claims User Acceptance Tester (UAT) will be responsible for validating whether all the business requirements have been fulfilled before releasing the actual product to production. The individual will perform positive and negative testing to identify and ensure any defects found are corrected prior to implementation. The Claims UAT will develop and follow a test plan w

Senior Director of Behavioral Health Strategy Job Ref 105750 Category Behavioral Health Department BEHAVIORAL HEALTH HARP Location 50 Water Street, 7th Floor, New York, NY 10004 Job Type Regular Employment Type Full Time Hire In Rate $200,000.00 Salary Range $200,000.00 $216,000.00 Empower. Unite. Care. MetroPlusHealth is committed to empowering New Yorkers by uniting com

Under the direction of the Team Lead and Care Manager, the Health & Wellness Advisor I (HWA I) is a member of a team that provides care management services to our high risk Medicaid members to ensure the promotion of their health and wellness. As an integral team member, the HWA I will work in conjunction with the Care Manager to ensure the member receives Comprehensive o

MuleSoft Solution Architect & Manager Job Ref 105687 Category Information Technology Department INFORMATION TECHNOLOGY Location 50 Water Street, 7th Floor, New York, NY 10004 Job Type Regular Employment Type Full Time Hire In Rate $170,000.00 Salary Range $170,000.00 $180,000.00 Empower. Unite. Care. MetroPlusHealth is committed to empowering New Yorkers by uniting commun

Senior Director of Medical Directors Job Ref 102619 Category Utilization Review and Case Management Department UTILIZATION MANAGEMENT Location 50 Water Street, 7th Floor, New York, NY 10004 Job Type Regular Employment Type Full Time Salary Range $340,000.00 $350,000.00 Empower. Unite. Care. MetroPlusHealth is committed to empowering New Yorkers by uniting communities thro

Under the supervision of the Director of Clinical Case Management in the Behavioral Health HARP department, the Behavioral Health (BH) Care Manager Team Lead is responsible for the supervision of Care Managers (CM) within the BH Mainstream CORE Unit including coordinating daily operations and overseeing case management. The BH CM Team Lead monitors the CM departmental ACD

Claims Quality Auditor is responsible for reviewing claims to determine if payments have been made correctly. This position analyzes data used in settling claims to determine the validity of payment of claims and reports overpayments, underpayments and other irregularities based upon benefit configuration, compliance with provider contract agreements, and Federal, State a