Supervises staff, ensures appropriate workload distribution and oversees day to day workflow processes. Ensures DSNP team is compliant with all Model of Care regulatory requirements and produces optimal clinical and resource outcomes. Works with case managers to assess, plan, implement, coordinate, monitor and evaluate services and outcomes to maximize the health of the member.
Reports to: Mgr, Care Management
Department: HS-Care Management
Location: Phoenix, AZ. & St.Louis, MO.
- Assists management in collaborating with Health Services, Operations and Information Technology departments to ensure full integration of case management reporting throughout the organization.
- Assists Case Mangers in completing comprehensive assessment and care plans to evaluate the member's need for services.
- Monitors associate performance and conducts counseling/corrective action procedures when required. Identifies concerns, brings issues to management's attention and offers suggestions for improvement.
- Provides significant input to 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 Case Managers 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 or director.
- Performs other duties as assigned
- Required An Associate's Degree in nursing or Graduation from Diploma Nursing School
- Preferred A Bachelor's Degree in nursing
- Required A Master's Degree in a related field For Illinois' Children with Special Needs program, a Master's degree in Nursing, Social Sciences, social work, or a related field plus 3 years of experience in a human services field is required.
- Required 4 years of experience in an acute clinical care setting and/or MCO related experience
- Required 2 years of experience in current case management
Licenses and Certifications:
- Intermediate Ability to drive multiple projects
- Intermediate Ability to work independently
- Intermediate Demonstrated time management and priority setting skills
- Intermediate Ability to work in a fast paced environment with changing priorities
- Intermediate Demonstrated written communication skills
- Intermediate Demonstrated interpersonal/verbal communication skills
- Intermediate Ability to create, review and interpret treatment plans
- Intermediate Demonstrated negotiation skills
- Intermediate Ability to lead/manage others
- Advanced Knowledge of medical terminology and/or experience with CPT and ICD-9 coding
- Advanced Ability to effectively present information and respond to questions from families, members, and providers
- Advanced Ability to effectively present information and respond to questions from peers and management
- Advanced Knowledge of healthcare delivery
- Intermediate Ability to implement process improvements
A license in one of the following is required:
- Required Licensed Registered Nurse (RN)
- Preferred Certified Case Manager (CCM)
- Required Intermediate Microsoft Word
- Required Intermediate Microsoft Excel
- Required Intermediate Healthcare Management Systems (Generic)
- Preferred Other Bilingual skills