Manages the activities of supervisory associates and their subordinate work group(s) and/or exempt individual contributors for assigned area of responsibility. Works with the Supervisor(s) and Case Managers to assess, plan, implement, coordinate, monitor, and evaluate services and outcomes to maximize the health of the Member.
Department: Long term Care
Reports to: Sr Director, Field Health Services
Additional Responsibilities:Candidate Education:
- Manages and develops direct reports who include supervisory and/or exempt professional personnel including but not limited to hiring, mid-year and annual reviews, Performance Improvement Plans (PIP), terminations, etc.
- Develops and implements case management workflows and policies & procedures.
- Partners & collaborates with other departments cross functionally regarding case management and/or Clinical Services initiatives.
- 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.
- Develops, implements and manages process improvement initiatives.
- Establishes objectives, schedules, and manages cost data for Case Management Department.
- Coordinates activities of unit to meet contractual company deadlines and resolves interpersonal conflicts.
- Applies a comprehensive knowledge of Case Management to the completion of assignments.
- Proactively monitors appropriate metrics to drive up efficiency.
- Chairs case management committees as applicable.
- Maintains current knowledge of case management topics and acts as the unit's subject matter expert (SME) on case management at department and company meetings.
- Performs special projects as needed.
- Required A Bachelor's Degree in Nursing or Health Administration
- Required or equivalent work experience In Nursing in a clinical setting and/or MCO
- Required 5 years of experience in An acute clinical care setting and/or MCO related experience
- Required 3 years of experience in Case management
- Required 1 year of management experience
Licenses and Certifications:
- Intermediate Ability to work independently Ability to work independently, handle multiple assignments and prioritize workload
- Intermediate Demonstrated time management and priority setting skills
- Intermediate Ability to work in a fast paced environment with changing priorities
- Intermediate Ability to drive multiple projects
- Intermediate Demonstrated written communication skills
- Intermediate Demonstrated interpersonal/verbal communication skills
- Intermediate Ability to create, review and interpret treatment plans Ability to create, review and interpret treatment plans
- Intermediate Demonstrated negotiation skills
- Intermediate Ability to lead/manage others
- Advanced Knowledge of healthcare delivery
- 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
- Intermediate Ability to implement process improvements
- Intermediate Knowledge of medical terminology and/or experience with CPT and ICD-9 coding
A license in one of the following is required:
- Required Licensed Registered Nurse (RN)
- Preferred Certified Case Manager (CCM)
- Required Intermediate Microsoft Outlook Intermediate to high level efficiency in Microsoft Office including Outlook, Word and Excel
- Required Intermediate Microsoft Word
- Required Intermediate Microsoft Excel
- Required Intermediate Healthcare Management Systems (Generic) Intermediate to high level efficiency in Visio preferred
- Preferred Intermediate Microsoft Visio