Manages the day-to-day activities of the Field Care Management Team. 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. Promotes effective healthcare utilization, monitors health care resources and assumes a leadership role within the Interdisciplinary Care Team (ICT) to achieve optimal clinical and resource outcomes for member. Oversees the socio economic needs and services of selected member populations across the continuum of illness. Provides ongoing support and oversight to staff.
DEPARTMENT: Health Services
REPORTS TO: Director, Field Care Management
Additional Responsibilities:Candidate Education:
- Provides ongoing consultation to the care management team and reviews caseloads on an ongoing basis, both through regular face-to-face supervision sessions and review of management reports and deadlines.
- Assists Medical Director and Dir, Field Service Coordination in creating department goals, objectives and metrics.
- Oversees the implementation of programs and strategies.
- Develops and implements case management workflows and policies & procedures.
- Proactively monitors and tracks 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.
- Coordinates team activities to meet contractual company deadlines and resolves interpersonal conflicts.
- Partners & collaborates with other departments cross functionally regarding care and case management and/or Health Service initiatives.
- Directs work assignments, measures results and initiates personnel actions as required.
- Develops, implements and manages process improvement initiatives.
- Monitors associate performance and conducts counseling/corrective action procedures when required. Identifies concerns, brings issues to management's attention and offers suggestions for improvement.
- Reviews time records, sets schedules and approves all vacation/time off requests for subordinate associates.
- Provides training and guidance to new and current care management team regarding policy & procedure, systemic tools, workload and care/case plan development.
- Answers all questions and assists peers and management with delegated tasks or projects.
- Ensures compliance with all state and federal regulations as well as Corporate guidelines in day-to-day activities.
- Performs special projects as needed.
- Required An Associate's Degree in Nursing, Health and Human Services or a related field
- Preferred A Bachelor's Degree in Nursing or Health Administration
- Required Other For Florida Managed Long Term Care program, a Master's degree in human service, social science or health field plus a minimum of 3 years' experience in case management is required. OR Bachelor's degree in human service, social science or health field plus a minimum of 6 years' experience in case management is required
- Required Other For Illinois High Needs Children, a Master's Degree in Nursing, Social Sciences, Social Work or a related field AND a minimum of 3 years supervised experience in the human serviced field is required.
- Required 5 years of experience in case management, clinical acute care, home health, hospice, physician's office or public health
- Required 3 years of experience in managed care
- Required 1 year of management experience
- Preferred Other NCQA, EQRO accreditation experience
- Preferred Other Specialty Experience - In consideration of a specialty program or as a specific discipline leader i.e. Obstetrics, must have at least 5 years of experience or hold a national certification in that area of specialty (in states where applicable)
- Required Other For Florida Managed Long Term Care program, 1 years experience in working with the elderly and disabled population and case management experience.
- Required Other For Illinois High Needs Children program, a minimum of 3 years of Supervised experience in the Human Services field is required.
Licenses and Certifications:
- Intermediate Ability to communicate and make recommendations to upper management
- Intermediate Demonstrated time management and priority setting skills
- Intermediate Ability to lead/manage others
- Intermediate Ability to create, review and interpret treatment plans
- Intermediate Demonstrated negotiation skills
- Intermediate Demonstrated problem solving skills
- Intermediate Demonstrated interpersonal/verbal communication 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 Demonstrated written communication skills
- Intermediate Knowledge of healthcare delivery
- Intermediate Ability to multi-task
- Intermediate Demonstrated written communication skills
- Intermediate Other Abilty to lead and manage others in a metric driven environment
- Intermediate Ability to implement process improvements
- Intermediate Other Knowledge of medical terminology and/or experience with CPT and ICD 10 coding
A license in one of the following is required:
- Required Other One of the following licenses is required
- Required Licensed Registered Nurse (RN)
- Required Licensed Certified Social Worker (LCSW)
- Required Licensed Clinical Mental Health Counselor (LCMHC)
- Required Other Maintain required contact hours to fulfill regulatory requirements
- Preferred Certified Case Manager (CCM)
- Required Other For Illinois' High Needs Children, either than RN or any Master's level Behavioral Health clinical licenture is required.
- Required Intermediate Microsoft Excel
- Required Intermediate Microsoft Word
- Required Intermediate Microsoft Outlook
- Required Intermediate Healthcare Management Systems (Generic)