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Director of Medicare Operations-ISNP in Bronx, NY at Pride Health

Date Posted: 11/20/2018

Job Snapshot

  • Employee Type:
    Full-Time
  • Location:
    Bronx, NY
  • Experience:
    Not Specified
  • Date Posted:
    11/20/2018

Job Description

Director of Medicare Operations  

Responsible for the administrative and clinical functions of the Institutional Special Needs Plan (ISNP).

Will be responsible for meeting CMS regulatory requirements, including Plan's Model of Care, quality outcome and relationship management in the contracted Nursing Homes.

Will be in charge of development and implementation of Medicare Managed Care Strategies Related to chronically ill, Medicare eligible long term care population through Medicare Special Needs Plans.  

Will supervise 6 the Nurse Practitioners and Care managers.  

Responsible for ensuring that all annual assessments are completed timely including all appropriate diagnostic codes, work with finance to ensure diagnostic codes are not inadvertently dropped if still active, engage in pharmaceutical use review and establishing/implementing procedures to successfully meet CMS/NYSDOH quality measures and processes to identify and curtail unnecessary services and avoidable hospitalizations.

Must be a Nurse Practitioner