Dir, Field Care Management

Ensures the case management process of assessing, planning, implementation, coordination, monitoring, and evaluating services and outcomes is pursued to maximize the health of the member. Oversees the socio economic needs and services of selected member populations across the continuum of illness. Takes part in extensive community outreach to garner relationships with key stakeholder groups and organizations.

Department: Health Services

Reports to: VP, Field Health Services

Location: Rocky Point, FL

Essential Functions:

  • Manages and develops direct reports who conduct both case management and social service functions within a member's care plan.
  • Sets operational priorities and manages resources to operational goals and budgets.
  • Proactively monitors appropriate metrics to drive up efficiency.
  • Directs the case management process, providing advice when necessary of complex, controversial and/or unique administrative processes, medical procedures and payment guidelines.
  • Establish, maintain and foster professional working relationships with all providers and community stakeholders.
  • Partners & collaborates with other departments cross functionally regarding care and case management and/or Health Service iniatitives.
  • Manages & resolves e-mails and escalated phone issues in response to provider, staff and other department requests.
  • Directs work assignments, measures results and initiates personnel actions as required.
  • Participates in continuous quality improvement projects that involve case and social service components.
  • Ensure timely and complete delivery of required regulatory reports.
  • Serve on community advisory boards and task forces to address workforce and other long-term care challenges.
  • Ensures compliance with all state and federal regulations and guidelines for all lines of business.
  • Performs other duties as assigned.
Additional Responsibilities:
    Candidate Education:
    • Required A Bachelor's Degree in Nursing, Health Admnistration or directly related field
    Candidate Experience:
    • Required 10 years of experience in current case management
    • Required 5 years of management experience
    • Required 5 years of experience in managed care
    Candidate Skills:
    • Intermediate Ability to communicate and make recommendations to upper management
    • Intermediate Demonstrated time management and priority setting skills
    • Intermediate Ability to create, review and interpret treatment plans
    • Intermediate Ability to lead/manage others
    • Intermediate Demonstrated problem solving skills
    • Intermediate Demonstrated interpersonal/verbal communication skills
    • Intermediate Demonstrated negotiation skills
    • Intermediate Knowledge of community, state and federal laws and resources
    • Intermediate Demonstrated written communication skills
    • Intermediate Ability to effectively present information and respond to questions from families, members, and providers
    • Intermediate Ability to effectively present information and respond to questions from peers and management
    • Intermediate Knowledge of healthcare delivery
    • Intermediate Ability to lead/manage others in a matrixed environment
    • Intermediate Ability to implement process improvements
    • Advanced Other Strong clinical knowledge of broad range of medical practice specialties
    Licenses and Certifications:
    A license in one of the following is required:
    • Required Other Either a Licensed Registered Nurse (RN) or Licensed Clinical Social Worker (LCSW) license is required.
    • Preferred Certified Case Manager (CCM)
    • Required Other Maintain required contact hours to fulfill regulatory requirements
    • Required Other For IL, Special Needs Kids, candidate can be an independent licensed mental health professional, LCSW, LCPC, LMHC, LMFT, LPC etc
    Technical Skills:
    • Required Intermediate Microsoft Outlook
    • Required Intermediate Microsoft Word
    • Required Intermediate Microsoft Excel
    • Required Intermediate Microsoft PowerPoint
    • Required Intermediate Healthcare Management Systems (Generic)
    • Required Intermediate Microsoft Visio

      About us
      Headquartered in Tampa, Fla., WellCare Health Plans, Inc. (NYSE: WCG) focuses exclusively on providing government-sponsored managed care services through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans to families, children, seniors and individuals with complex medical needs. WellCare is a Fortune 500 company, and in 2018, was recognized as a Fortune "World's Most Admired Company", ranking in the top five among the health insurance and managed care industry-a testament to the hard work and dedication of the company's nearly 9,000 associates who each day live WellCare's values and deliver on its mission to help its members live better, healthier lives. The company serves approximately 4.4 million members nationwide as of Dec. 31, 2017. For more information about WellCare, please visit the company's website at www.wellcare.com. EOE: All qualified applicants shall receive consideration for employment without regard to race, color, religion, creed, age, sex, pregnancy, veteran status, marital status, sexual orientation, gender identity or expression, national origin, ancestry, disability, genetic information, childbirth or related medical condition or other legally protected basis protected by applicable federal or state law except where a bona fide occupational qualification applies. Comprehensive Health Management, Inc. is an equal opportunity employer, M/F/D/V/SO.