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New York - Albany

Nurse Care Manager
Geriatric Support Services Coordinator
Community Resource Coordinator

New York - Manhattan

Business Development Managers
Marketing Outreach Representatives
Marketing Coordinator
Provider Relations Representatives
Network Development Representatives
Community Resource Coordinator
RN Care Manager
Utilization Management RN
Manager, Pharmacy
Administrative Assistant, Clinical
Senior Administrative Assistant
Enrollment Coordinator
Director, Clinical Services
Director, Client Services
Brand Manager

New York - Albany

Nurse Care Manager

Nurses work independently within a supportive organization of professional colleagues. SWH cares for elders through the care continuum. In collaboration with the elder’s primary care physician and an interdisciplinary team, the Nurse Care Manager develops, implements and monitors an individual care plan and comprehensive services’ package for our members. Our goal is to improve the health status, functioning and quality of life for SWH members in their preferred place of residence.

Requirements – NY Registered Nurse License; strong clinical and assessment skills; outstanding communication skills; self-motivation, organization and flexibility; commitment to improve care in underserved populations; collaborative work style; relationship building; entails meeting directly with members, their families and providers in home and office settings; high level of accountability; reliable transportation; computer skills. Home care, long term care, care management experience a plus.

Also seeking a Nurse Care Manager, Disease Management.

Geriatric Support Services Coordinator

The Geriatric Support Services Coordinator (GSSC) is responsible for conducting comprehensive in-home assessments and reassessments of identified members to review their need for non-medical support services and referral to community resources. The GSSC coordinates with the SWH Care Managers, Community Resource Coordinators, and community agencies to recommend access to eligible benefits and community services that will promote optimal independence and functioning of SWH members.

Responsibilities include, but are not limited to:

Conducts a comprehensive evaluation/assessment to determine the full scope of members’ needs and periodic reassessments of member’s status
Identifies unmet needs based upon outcomes of the assessment and recommends a service plan that may include SWH benefits if eligible and linkage to community resources as well.
Provides ongoing support to members as needed.
Participates in nursing home discharge meetings for identified members and contributes to developing a supportive service plan for members prior to discharge.
Documents all activities including assessments, reassessments, encounters and data in a timely and accurate manner.
Develops and maintains relationships with community service organizations, social services, and public resources providing services to members.

Bachelor’s Degree with valid driver’s license. One year experience working in a human service position with the elder population. Extensive knowledge of the elder service/adult social service delivery system. Knowledge of Medicare and Medicaid system a plus. Ability to multi-task and work in a fast-paced environment. Bilingual ability an asset.

Community Resource Coordinator

The Community Resource Coordinator (CRC) will work directly with members, Case Managers, providers and community service organizations to ensure that members have access to the range of supportive services needed to promote optimal functioning and quality of life. The CRC will educate the member regarding plan benefits, identify and arrange needed social and health support services and follow up with the member on an ongoing basis.

Ideal candidates will have

Extensive knowledge and experience with community organizations, social services and public resources
Outstanding communication skills
Willingness to meet directly with members, their families and providers in office or home settings
Self starter with high level of accountability and responsibility for outcome of care
Flexibility
Highly organized and able to manage multiple priorities appropriately
Able to work collaboratively and build enduring relationships with providers, community and social service organizations, members and the multidisciplinary team
Computer skills
Bi–lingual skills required

New York - Manhattan

Business Development Managers

The Business Development Manager works in coordination with the Marketing department management and the Outreach staff to facilitate and support ongoing enrollment within key growth targets. He/She is responsible for the planning, development, training and implementation of the Regional Sales strategy by coordinating and overseeing the ground-level activity needs associated with the growth strategies.

Responsibilities include, but are not limited to:

Facilitates development discussions with Marketing department management, helping to identify follow up items and timelines for strategy implementation.
Fosters relationships on a ground level with key growth targets
Schedules field time to follow up with individual growth targets on items needed to support strategy implementation, including;

Orientations
Education
Reinforcement of messaging
Troubleshooting
Fact finding/problem solving
Staff relations

Provides communication of salient issues to provider relations contact, as needed

Bachelor’s Degree and valid NY Life, Accident & Health insurance licensure required. 4+ years of Medicare/Medicaid enrollment experience. Highly motivated with the discipline to work independently with minimal supervision. Ability to identify market and customer trends, identifying potential solutions. Excellent communication and interpersonal skills. Strong presentation skills. 90% local travel.

Marketing Outreach Representatives

The Marketing Outreach Representative follows up on sales leads and information requests for potential participants; assists potential members in the application process; submits applications for processing; arranges for and conducts community outreach activities, and; participates in retention programs. Bi-lingual candidates strongly preferred.

Responsibilities include, but are not limited to:

Assists potential members in the application process
Provides information and answers to all questions from potential members regarding benefits, rights and responsibilities, and plan operations
Meets and reviews monthly sales-related goals and objectives;
Completes all required documents;
Employs lead generation and follow up according to SWH standards;
Maintains ongoing knowledge of changes to Medicare and Medicaid regulations and their impact on daily operations;
Identifies and organizes community outreach activities to spread awareness of coverage option(s).

Bachelor’s Degree with 4+ years of Medicare and/or Medicaid enrollment experience. Highly motivated with the discipline to work independently with minimal supervision. Ability to identify market and customer trends, identifying potential solutions. Excellent communication and interpersonal skills. Strong presentation skills. 90% local travel.

Marketing Coordinator

The Marketing Coordinator assists the Marketing and Branding Director and supports the marketing department by updating and developing marketing reports, keeping track of departmental projects timelines and completion dates. It works with internal departments to update pre-enrollment, post-enrollment and all other marketing materials. He/She will assist in developing marketing material and communicate with outside vendors to update company material’s copy and design.

Responsibilities include, but are not limited to:

Updating department reports and marketing analysis
Communicates with external vendors to update marketing materials
Keep track of all marketing projects to ensure deadline dates are met
Develop and maintain library of all marketing and communication materials
Work collaboratively with internal departments to meet the department’s objectives as directed by the Marketing and Branding Director.
Coordinates meetings and conference calls with internal departments and outside vendors
Performs clerical duties as directed by the department director
Maintains and updates project request database
Supports internal departments to market and promote community outreach activities
Assist in office support functions as required
Maintain and updates CRM management
Assist in monitoring/reporting outcomes of marketing campaigns
Assist in communication with internal on updated policies and procedures

Bachelor’s Degree preferred. 4-6 years of Marketing experience. Proficient in MS Office. Highly motivated with the discipline to work independently. Ability to identify market and customer trends, identifying potential solutions. Excellent interpersonal skills and comfort with corporate sales environment. Strong presentation and sales skill sets. 25% local travel.

Provider Relations Representatives

The Provider Relations Representative is responsible for assisting and servicing all providers in the network as well as developing and managing relationships with providers. These responsibilities include: outreach; education and training of contracted providers; monitoring and resolution of operational and/or contractual problems; support of recruitment and other expansion efforts including Member enrollment.

Responsibilities include, but are not limited to:

Orient and train providers regarding Senior Whole Health operations
Meet with key hospital, physician group, and community-based providers on a regular basis to identify problems and/or concerns; maintain relations with key provider contacts to ensure and support mutually beneficial relationships and ongoing collaboration
Assist providers as necessary with problem resolution
Work with internal staff to resolve provider issues with regard to billing, payments, denials, authorizations, and other interactions
Assist in ongoing identification of providers needed for network completion or expansion
Distribute and collect provider contracts; prepare contract/application packets for credentialing
Support the Provider Relations ACD line (call line) and the Provider Relations email box
Manage and/or support other projects and activities as assigned

Bachelor’s Degree required. Local travel up to 50%, 3 plus years experience working in a health care environment (preferably in the managed care industry) and experience working with managed care systems (claims processing, enrollment, etc.) Direct Provider Relations experience highly desirable. Strong customer service and marketing skills. Ability to work well with physicians, clinicians, practice and health system administrators, frontline provider staff and Senior Whole Health staff.

Network Development Representatives

The responsibilities of the Network Development Specialist include, but are not limited to:

Develop and manage a portfolio of SWH contracts
Participate in and manage Provider Relations/Network Development related projects.
Recruit, develop, and maintain a robust provider network to meet SWH membership and growth needs.
Monitor and manage contracts to ensure compliance with regulatory requirements. The network management portfolio includes, and is not limited to, contracts with hospitals and health systems, group practices, physicians, long term care providers, and other ancillary providers.
Work closely with other departments within SWH on various projects.

The position will cover an assigned regional area. This position may also be responsible for projects including, but not limited to, regulatory language compliance for provider contracts.

Bachelor’s Degree or equivalent related experience. 5-7 years experience working in a health care environment; preferably in an HMO/PPO setting and 3-5 years contract negotiations and/or provider relations experience required. An excellent working knowledge of healthcare contract language is required. Up to 70% travel within assigned region. Strong communication skills, both verbal and written, excellent interpersonal skills, and the demonstrated ability to influence internal and external customers.

Community Resource Coordinator

Ideal candidates will have:

Extensive knowledge and experience with community organizations, social services and public resources
Outstanding communication skills
Willingness to meet directly with members, their families and providers in office or home settings
Self starter with high level of accountability and responsibility for outcome of care
Flexibility
Highly organized and able to manage multiple priorities appropriately
Able to work collaboratively and build enduring relationships with providers, community and social service organizations, members and the multidisciplinary team
Computer skills
Bi–lingual skills preferred

RN Care Manager

New York Registered Nurse License; strong clinical and assessment skills; outstanding communication skills; self-motivation, organization and flexibility; commitment to improve care in underserved populations; collaborative work style; relationship building; entails meeting directly with members, their families and providers in home and office settings; high level of accountability; computer skills. Home care, long term care, care management experience a plus.

Utilization Management RN

The SWH Utilization Management nurse is responsible for performing concurrent and retrospective utilization review and facilitating discharge planning.

Responsibilities include, but are not limited to:

Perform concurrent and retrospective utilization review using Interqual criteria to assure that the appropriate level of care is maintained throughout the patient’s hospital stay.
Provide coordination of complex discharge planning needs and referrals to appropriate support services.
Prepare and evaluate quality and utilization management reports.
Participate in clinical rounds and collaborate on post-acute care planning with Community Nurse Care Management colleagues.
Refer cases to the SWH Medical Director for review as appropriate.

Minimum of two years prior utilization management experience (admissions, utilization review, and/or discharge planning). Strong knowledge of Medicare/Medicaid programs and clinical and assessment skills. Able to work collaboratively and build enduring relationships with providers, members and the multidisciplinary team. Approximately 50% travel.

Manager, Pharmacy

Manages day-to-day corporate pharmacy operations and leads efforts in New York City both clinically and with retail pharmacy relationships. Candidate will have the opportunity to be on the ground floor for an expansion of an established Medicare Special Needs Health Plan. He/She will be the sole Pharmacist on the regional team, but there is collegial support of other plan Pharmacists.

Responsibilities include both clinical and management components in a managed care pharmacy department. Responsibilities include but are not limited to:

Fulfills all functions of the Pharmacy Director when Director is not available
Provides a leadership role for the department in cooperation with the Director
Direct supervision of Pharmacy Project Coordinators and students involved in the day-to-day operations of the department
Responsible for developing pharmacy network relationships for the New York City Office
Assists in developing other relationships with clinical providers to SWH members
Responsible for the pharmacy clinical support in the New York City Office
Attends meetings as required (MAC, P&T, QMC, Rounds)
Supports corporate programs and initiatives relating to pharmacy
Works directly with the plans PBM
Understands and manages benefit issues with regards to pharmacy in compliance with CMS requirements
Produces PBM reports and reviews analytics to propose new interventions and document successes
Advising and working with the pharmacy, nursing and medical staff of the plan on pharmacy related operations and projects
Takes call on nights and weekends, in rotation with other staff with additional compensation
Specific projects as required

Minimum of 5 years experience as a Pharmacist; minimum of 2 years in management. BS Pharmacy with NY license (or eligible for reciprocity). Additional MA license preferred. Advanced degree MBA or PharmD preferred. Managed care residency and Medicare and Medicaid experience preferred. Strong knowledge of health care contracts in NYC preferred.

Administrative Assistant, Clinical

The Administrative Assistant for the Clinical Department provides administrative and scheduling support to the Community RN Care Managers and the Director of Clinical Services, ensuring efficient, professional and confidential services.

Support services include data entry, telephone communication with home care companies, equipment companies, and various other entities regarding benefits and referrals, and timely communication with the SWH nurses. The Candidate will manage various processes and comply with deadlines for the department.

Proficient in MS Office, Excel and the ability to learn new computer programs essential. Demonstrated time management, organization, prioritization, and independent problem solving skills. Some knowledge in a healthcare related field and medical terminology preferable. Candidate will have the ability to work as a team member and have a customer service focus.

Senior Administrative Assistant

The Senior Administrative Assistant will be responsible for a range of special projects and will be wholly immersed in all facets of a growing company.

Responsibilities include, but are not limited to:

Assist the Executive Director with day-to-day organization, calendaring and scheduling
Supervise Administrative staff and Receptionist
Prepare PowerPoint presentations
Create and run reports, draft correspondence and prepare expense reports
Screening calls and emails
Filing contracts and managing confidential material
Coordinate calendars for members of senior management, and schedule meetings
Complete major projects by establishing objectives, determining priorities, managing time, soliciting the cooperation of others, monitoring progress, and meeting deadlines
Analyze and process sensitive and confidential information including company reports and correspondence
Organize and prepare for meetings, including coordinating catering and assembling materials
Identify areas for improvement in office operations
Organize and maintain file system, and file correspondence and other documents

Bachelor’s Degree of 3+ years of relevant office experience. Experience providing administrative support to an executive level professional is required. Solid proficiency in MS Office applications is a must. The ability to function effectively in a fast-paced environment and adapt quickly to change is essential.

Enrollment Coordinator

Coordinate and facilitate administrative enrollment process; responsible for developing and maintaining relationships with third party enrollment organizations; Assist organizations in coordinating and retaining Medicaid eligibility for members. Bi-lingual skills preferred.

Director, Clinical Services

The Director, Clinical Services is responsible for developing and directing a multi-faceted clinical team. In collaboration with Medical Direct, the Clinical Director will be responsible to manage the Plan’s clinical programs which result in positive clinical outcomes and quality measurements. Candidate will coordinate clinical initiatives with colleagues in affiliate companies; implement clinical services, disease management programs, and quality initiatives with a specific emphasis on geriatric and disadvantaged populations.

Responsibilities include, but are not limited to:

Direct clinical programs and services that will support the highest standards of quality and appropriate clinical services to the members of Senior Whole Health.
Collaborate with Medical Director to develop, implement, and monitor performance standards for clinical services and care management.
Assist in developing goals, strategies and management practices that will ensure growth, development and financial success.
Develop strategies to engage primary care physicians in the care model to which we are committed and identify those providers who are collaborative.
Recruit, train, develop and maintain a high quality clinical team of nursing and care management professionals.
Work with Director of Client Services, primary clinical providers, and Service Coordinators to assess and meet members’ care and service needs.
Work with the Medical Director to implement the geriatric care model across the continuum.
Oversee the administration of members’ benefits according to our policies and procedures in all care settings, including: service authorization and referral policies, hospital admission and discharge protocols, ancillary services management and assessment of benefit exceptions.

Candidate will be a clinical professional registered nurse in NY with Bachelors Degree in Nursing. Masters Degree in Nursing or Health Care Management strongly preferred. 10+ years experience in clinical care management. 5+ years management/supervisory experience. Understanding of the needs and dynamics of elder care services and disadvantaged populations. Significant experience with Quality Outcomes measurement and familiarity with clinical data systems and reporting. Significant management experience in a managed care or HMO setting is strongly preferred. Familiarity with Medicare and State Medicaid programs and hands-on experience with regulatory requirements and reporting. Up to 50% local travel.

Director, Client Services

Responsible for developing and directing our new Members Service Unit (Community Resource Coordinators) to ensure that Plan communications to our members are timely, accurate, supportive and of high quality. Candidate will design, implement and monitor operational programs to ensure that the outcome of all service interactions result in satisfactory resolution of inquiries and complaints. Develop and maintain collaborative relationships with community-based resources.

Responsibilities include, but are not limited to:

Direct member services programs that will support the highest quality and timely information provided to Members of SWH
Develop and maintain policies and procedures in accordance with SWH guidelines and regulatory requirements
Develop enduring relationships with members, providers, community and social service organizations to ensure that members have access to the range of supportive services needed to promote optimal functioning and quality of life
Develop strategies to ensure that timely and accurate information is developed and disseminated to SWH members
Coordinate member services activities with other internal support departments
Manage oversight of membership information and maintain data related to members.
Recruit, train, develop, and maintain a high quality team of member services staff

Candidate will have Bachelor’s degree in social / health sciences or business. Master’s degree in health care or social work preferred. 10+ years experience in a member services department, health care, or social services environment. Minimum 5 years management experience. Working knowledge of Medicare and Medicaid programs and experience with regulatory requirements and reporting. Knowledge of managed care and/or member services. Demonstrated experience in managing call center staff including recruitment, education, and training. Understanding of the needs and dynamics of elder care services and disadvantaged populations.

Brand Manager

The Brand Manager will be responsible for planning and developing business plans and directing and managing the Senior Whole Health brand strategies in order to increase consumer awareness.

Responsibilities include, but are not limited to:

Develop and implement innovative marketing strategies
Forecast volume and manage budget
Conduct consumer and market research
Develop promotions, packaging and advertising campaigns
Design and implement target-specific programs
Track and analyze business performance

Bachelors Degree with a minimum of 4 years relevant experience. Knowledge of the healthcare industry, Medicare/Medicaid an advantage. 4-6 years experience in the marketing industry. Extensive experience in all aspects of developing and maintaining marketing strategies to meet company objectives.

Last modified: 12/22/2011