Supv, Pediatric Field Care Management

Supervises staff, ensures appropriate workload distribution and oversees day to day workflow processes. Ensures team is compliant with all model of care regulatory requirements, and produces optimal clinical, socio economic and resource outcomes. 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. Carries an assigned case workload and assumes a leadership role within the interdisciplinary team. Works directly with the member in the field, i.e., inpatient bedside, member's home, provider's office, hospitals, etc. to assess, plan, implement, coordinate, monitor and evaluate services and outcomes to maximize the health of the member.

Reports to: Director, Field Care Management

Department: Case Management

Location: Dade


Essential Functions:

  • Supervises daily activities of the Field Service Coordination staff ensuring performance standards are met.
  • Implements case management work flows and policies & procedures.
  • Proactively monitors appropriate metrics to drive up efficiency.
  • Perform audits of assessments, care plans and service notes to verify cases are properly established and that member coordination activities are occurring and appropriately documented.
  • Carries an assigned case workload. Completes a comprehensive assessment and develops a care plan utilizing clinical expertise to evaluate the members need for alternative services. Assess short-term and long-term needs and establish case management objectives.
  • Interacts continuously with member, family, physician(s), and other providers utilizing clinical knowledge and expertise to determine medical history and current status. Assess the options for care including use of benefits and community resources to update the care plan.
  • Act as liaison and member advocate between the member/family, physician and facilities/agencies.
  • Maintains accurate records of case management activities in the Enterprise Medical Management Automation (EMMA) System using clinical guidelines.
  • Conducts performance evaluation, hiring and termination decisions for associates in work group.
  • Reviews time records, sets schedules and approves all vacation/time off requests for subordinate associates.
  • Provides training and guidance to new and current Field Service Coordinators and/or Social Workers regarding policy & procedure, systemic tools, workload and care plan development.
  • Answers all questions and assists peers and management with delegated tasks or projects.
  • Takes the lead in preparing and submitting projects, reports or assignments as needed to meet department initiatives and/or objectives.
  • Ensures phone or team coverage due to fluctuations in staffing levels.
  • Ensures regulatory requirements and accreditation standards are applied to all activity and reporting.
  • Plays active role in creating, applying and utilizing accepted policies and procedures.
  • Attends company meetings in absence of manager.
  • Ensures compliance with all state and federal regulations as well as Corporate guidelines in day-to-day activities.
  • Perform other duties as assigned.
Additional Responsibilities:
  • Travel to inpatient bedside, member’s home, provider’s office, hospitals, etc required with dependable car. May spend up to 70% of time traveling with exposure to inclement weather and normal road hazards.
Candidate Education:
  • Required A Bachelor's Degree in Nursing, Health Administration or a directly related field
  • Required or equivalent work experience
  • Required Other For Illinois' Children with High Needs program, a Master’s degree in Nursing, social sciences, social work or related field and a minimum of three (3) years of supervised experience in a human services field.
Candidate Experience:
  • Required 4 years of experience in case/behavioral management and/or clinical acute care experience
  • Required 3 years of experience in managed care
  • Required 1 year experience in leading/supervising others
  • Required Other Experience in care of the elderly is required in some geographic regions
  • Required Other Understands the business and financial aspect of case/behavioral management in a managed care setting
  • Preferred Other Prior utilization management experience preferred in some geographic regions
  • Preferred Other Home health, physicians office or public health experience a plus
  • Required Other Associates supporting Florida's Children’s Medical Services (CMS) will have a minimum on three (3) years of management/supervisory experience in a healthcare setting and one of the following: An RN License must have a minimum of two (2) years’ experience in Pediatrics -OR- A MA degree in Social work with at least 1 year of related professional experience
Candidate Skills:
  • Intermediate Ability to communicate and make recommendations to upper management
  • Intermediate Demonstrated time management and priority setting skills
  • Intermediate Ability to multi-task
  • Intermediate Ability to lead/manage others
  • Intermediate Ability to create, review and interpret treatment plans
  • Intermediate Demonstrated negotiation skills
  • Intermediate Demonstrated interpersonal/verbal communication skills
  • Intermediate Demonstrated problem solving skills
  • Intermediate Knowledge of community, state and federal laws and resources
  • 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 families, members, and providers
  • Intermediate Ability to work independently
  • Intermediate Other Previous experience working with treatment teams to meet the healthcare needs of participants
  • Intermediate Demonstrated written communication skills
  • Intermediate Other Ability to lead and manage others in a metric driven environment
  • Intermediate Ability to implement process improvements
  • Intermediate Other Strong clinical knowledge of broad range of medical practice specialties
  • Intermediate Knowledge of healthcare delivery
  • Other
Licenses and Certifications:
A license in one of the following is required:
  • Required Licensed Registered Nurse (RN)
  • Required Licensed Certified Social Worker (LCSW)
  • Preferred Other For NJ LTC, licensed RN or licensed behavioral health professional
  • Preferred Certified Case Manager (CCM)
Technical Skills:
  • Required Intermediate Microsoft Word
  • Required Intermediate Microsoft Outlook
  • Required Intermediate Microsoft Excel
  • Required Intermediate Healthcare Management Systems (Generic)
Languages:

    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.