Director, Liability Claims overseeing medical professional and general liability claims for hospitals. Responsible for investigation, evaluation, and resolution of claims and managing claims litigation.
About the role
- Assistant Director of Social Services overseeing clinical management and Medicaid eligibility for ESH members. Supervising social service staff and ensuring compliance with New York State regulations.
Responsibilities
- Assists the VP of Social Work and Community Health Services to assure that appropriate, high-quality clinical management is provided to all ESH members in accordance with relevant regulations.
- Provides direct managerial oversight and supervision to the social service staff in the MLTC Program.
- Oversees the Medicaid eligibility department, addresses and resolves unpaid Medicaid claims and Medicaid surplus payments issues.
- Assures Medicaid applications, renewals, deferrals and conversions are completed on time.
- Responsible for establishing appropriate, New York State code compliant, personnel policies and procedures including those relating to hiring practices, health status examination, and periodic evaluation.
- Orientation and in-service education.
- Participates in hiring, retention, evaluating, disciplining and termination of staff.
- Ensures compliance, consistent with health rules of the New York State Department of Health.
- Performs clinical oversight of contracted agency social workers.
- Participates in developing standards which insure safe and therapeutically effective service to clients and families.
- Oversees the clinical supervision of staff to assure standards of care are met and/or assures that appropriate supervision is provided.
- Participates in the planning, development, implementation and evaluation of staff orientation and in-service Education programs.
- Represents Program at Professional Meetings.
- Provides direct supervision of clinical staff and eligibility specialists.
- Prepares for the participation in certification visits from Regulatory/Accrediting bodies.
- Represents Program to community.
- Reviews weekly claims report and report findings with the VP of Social Work & Community Health Services or designee.
- Monitors clinical quality (productivity Data collection, assessment, care planning, documentation) and provide case consultation on complex cases (abuse/neglect, suicidality, housing and benefits crises).
Requirements
- Master's of Social Work degree required
- Five (5) years experience as a Social worker required
- Three (3) years of management experience (e.g., CHHA, MLTCP or PACE Program) required
- Knowledge of duties and ability to perform and supervise social workers and eligibility specialists.
- Knowledge of planning, organization, directing, coordinating and evaluating clinical aspects of social work and social services.
- Ability to multi-task.
- Demonstrates working knowledge of Medicaid, Medicare, including enrollment and recertification.
- Knowledge of Pooled Income trust (UCS & NYSARC).
- Knowledge of NASW code of Conducts
- Demonstrates knowledge of community-based resources, entitlement programs, and benefits systems such as SNAP, SSI/SSDI, housing subsidies and fuel assistance.
- Ability to provide clinical consultation and guidance on complex, high-risk cases involving behavioral health crises, abuse/neglect, homelessness, substance use disorders, or unsafe discharges.
- Ability to ensures timely, accurate, and clinically appropriate documentation in the electronic medical record.
- Ability to assist the VP in the development of policies, procedures, and workflows for the social services department.
- Assuring adherence to good personnel practices in regard to hiring, retention, evaluation, counseling, discipline and termination of personnel.
- Ability to set and achieve goals
- Ability to effectively communicate information with geriatric and chronically ill clients.
- Ability to interact in a positive and helpful manner with clients and participants.
- Ability to understand the needs of the geriatric and chronically ill clients.
Benefits
- substantial and comprehensive total rewards package
Job title
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