Manages the day-to-day activities of the Field Service Coordinators (Field Case Managers) and Supervisors. 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: Sr. Director, Field Health Services
- Provides ongoing consultation to Field Service Coordinators 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 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 activities of unit 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 Field Service Coordinators 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.
- Will travel within state as needed to manage remote staff.
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 years of people management experience.
Preferred, NCQA, EQRO accreditation experience; Specialty Experience - inconsideration of a specialty program or as a specific discipline leader, i.e. Obstetrics, must have at least 5 years of experience of hold a national certification in that area of specialty in states where applicable.
Licenses and Certifications:
Required Registered Nurse (RN) in state of practice, with no restrictions.
Required to maintain required contact hours to fulfill regulatory requirements.
Preferred Certified Case Manager (CCM); Specialty Experience- national certification in that area of specialty in state where applicable.
Intermediate ability to communication 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 and verbal communication skills.
Intermediate knowledge of healthcare delivery.
Intermediate ability to multi-task.
Intermediate ability to lead and manage others in a metric driven environment.
Intermediate ability to implement process improvements.
Intermediate knowledge of medical terminology and/or experience with CPT and ICD9/10 coding.
Required intermediate skill level or stronger with MS Excel, Word, Outlook.
Required intermediate skill level with generic Healthcare Management Systems.