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

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

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

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

The primary function of the Quality Management (QM) Health Navigator is to outreach members missing important health screenings (i.e., HEDIS/QARR gaps in care) to assist in coordinating needed appointments for a variety of clinical and social services and ensuring maintenance medications are filled regularly. The QM Health Navigator will serve as a source of empowerment f

Director of Encounter Data Reporting Job Ref 102396 Category Professional Department ANALYTICS AND REPORTING Location 50 Water Street, 7th Floor, New York, NY 10004 Job Type Regular Employment Type Full Time Hire In Rate $140,000.00 Salary Range $140,000.00 $150,000.00 Empower. Unite. Care. MetroPlusHealth is committed to empowering New Yorkers by uniting communities thro

The Complaints Coordinator provides comprehensive customer service to members, providers, and prospective members. The primary responsibilities include but are not limited to documenting all customer contacts into the tracking system, process complaints, assisting supervisory staff with complaints review, handle escalated issues and assist the management team with special

The Care Manager under the direction of the Vice President of Clinical Services, is primarily responsible for managing both simple and complex medical cases to achieve high quality patient care outcomes and minimize unnecessary medical expenses, through the coordination of services, both outpatient and inpatient. The Care Manager will assist the provider in directing care

Customer Success Specialist (Bilingual Spanish) Job Ref 85554 Category Member Services Department MHP CUSTOMER SUCCESS Location 50 Water Street, 7th Floor, New York, NY 10004 Job Type Regular Employment Type Full Time Hire In Rate $45,277.00 Salary Range $45,277.00 $50,000.00 Empower. Unite. Care. MetroPlusHealth is committed to empowering New Yorkers by uniting communiti

Customer Success Specialist (Bilingual Korean) Job Ref 81576 Category Member Services Department MHP CUSTOMER SUCCESS Location 50 Water Street, 7th Floor, New York, NY 10004 Job Type Regular Employment Type Full Time Hire In Rate $45,277.00 Salary Range $45,277.00 $45,277.00 Empower. Unite. Care. MetroPlusHealth is committed to empowering New Yorkers by uniting communitie

Customer Success Specialist (Bilingual Chinese) Job Ref 81579 Category Member Services Department MHP CUSTOMER SUCCESS Location 50 Water Street, 7th Floor, New York, NY 10004 Job Type Regular Employment Type Full Time Hire In Rate $45,277.00 Salary Range $45,277.00 $50,000.00 Empower. Unite. Care. MetroPlusHealth is committed to empowering New Yorkers by uniting communiti

Customer Success Specialist (Bengali / Hindi / Urdu) Job Ref 81577 Category Member Services Department MHP CUSTOMER SUCCESS Location 50 Water Street, 7th Floor, New York, NY 10004 Job Type Regular Employment Type Full Time Hire In Rate $45,277.00 Salary Range $45,277.00 $50,000.00 Empower. Unite. Care. MetroPlusHealth is committed to empowering New Yorkers by uniting comm

The Customer Success Specialist is responsible for supporting MetroPlusHealth members and other key stakeholders across the customer's journey. They are experts on the system and understand the NYSOH processes to quickly route members to the appropriate resolution and support. The Specialist will work as a liaison to ensure proper processes are introduced and implemented