Manager Case Management Long-term Care

Company :

Job Description : 

JOB SUMMARY

This job supervises a team of Case Manager Supervisors who are charged with promoting quality member outcomes, optimizing member benefits, and promoting effective use of resources. The incumbent ensures care is medically appropriate, high quality, and cost effective and is accountable for the oversight development and maintenance of the department's case management processes. This includes utilization management, strategic planning, care cost initiatives, system development, compliance and quality outcomes. Hires, trains, coaches, counsels, and evaluates performance of direct reports. The incumbent works closely with other departments within the corporation to resolve issues and to ensure activities coincide with case management processes.  Supports an interdisciplinary approach to meeting members’ needs through a strong collaborative relationship with external stakeholders as well as internal departments including but not limited to Medical Directors, Behavioral Health Teams, Disease Management, and Utilization Review.  The incumbent is accountable for special projects and enhanced activities within the department and accepts responsibility, in conjunction with the internal QA department, for meeting all reporting requirements as outline by the State of Delaware related to LTSS Case Management services. 

ESSENTIAL RESPONSIBILITIES

• Perform management responsibilities to include, but are not limited to: involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity. Plan, organize, staff, direct and control the day-to-day operations of the department; develop and implement policies and programs as necessary; may have budgetary responsibility and authority.
• Manage a team of Case Manager Supervisors.

• Oversee the development of, and updates to, policies and procedures to support regulatory requirements related to Case Management.

• Promote quality member outcomes to optimize member benefits and to promote effective use of resources while ensuring care is medically appropriate, high quality, and cost effective.

• Oversee the development and maintenance of the department's case management processes while ensuring compliance with regulatory agencies including but not limited to:  NCQA, URAC, CMS, DOH, and DOL.

• Promote strict adherence to all company, State and Federal requirements related to privacy practices, HIPAA, and quality performance standards.

• Collaborate with other departments, within the corporation, to resolve issues and ensure activities coincide with Case Management processes.

• Support an interdisciplinary approach to meeting members’ needs through a strong collaborative relationship with external stakeholders as well as internal departments including but not limited to Medical Directors, Behavioral Health Teams, Disease Management, and Utilization Review.  

• Accountable for special projects and enhanced activities within the department.

• Meet all reporting requirements as outline by the State of Delaware related to LTSS Case Management services. 

• Monitor and track direct reports for completion of assigned work.

• Provide service support, coordinate training and performance metrics/statistics to the team in addition to initiating and implementing process improvements. Assist with direct reports to problem solve escalated issues and identify and escalate issues appropriately.

• Organize and facilitate staff meetings that assure corporate and operational communication supported by meeting minutes; and providing an open forum for issues and problem solving.

• Suggest new approaches to complex problems.

• Set appropriate targets, measure outcomes and establish plans to negate variances in quality, staff retention, finance and customer satisfaction.

• Ensure all staff achieve the minimal qualifications, of their position, through ongoing staff development, counseling, individual and group education.

• Manage and coordinate all department activities, staff education, policy and procedure development and revision, and individual staff audits.

• Oversee overall operations to ensure compliance to standards.

• Recruit, select, orient, evaluate, counsel, and develop performance improvement plans for all direct reports.

• Promote and terminate per corporate policy, encourage career development and support of staff.

• Develop and implement appropriate audit requirements in order to ensure compliance of all staff activity related to Case Management.

• Maintain consistent and open lines of communication with internal and external customers.

• Communicate changes, in processes and programs, in order to enhance a shared vision and mission.

• Communicate outcomes, data analysis, complex processes and action plans to division/unit staff, corporate partners, and external customers.

• Facilitate and lead informational and educational meetings for internal and external customers.

• Coordinate, develop and implement department/division projects.

• Other duties as assigned/requested.

EDUCATION

Required

• Bachelor's degree in Health Administration, Public Health or related field

Substitutions

• 6 years of progressive relevant experience in lieu of Bachelor's degree

Preferred

• Master's degree in a related human services field.

EXPERIENCE

• 5 years of a clinical setting

• 3 years in a case management/managed care role

• 3 years in a management or leadership role

Preferred

• 1 year in a home clinical or case management role

• Medicare or Medicaid experience

LICENSES or CERTIFICATIONS

Required

• Current, valid, unrestricted license in one or more of the following disciplines: RN, LCSW, LSW, LPC, or other related clinical license

Preferred

• CCM - Certified Case Manager Certification

SKILLS

• Leadership, collaboration, and motivational skills

• Ability to multi task and perform in a fast paced, and often intense environment

• Excellent written and verbal communication skills

• Ability to analyze data, measure outcomes and develop action plans

• Enthusiastic, innovative and flexible.

• Team player that possesses strong analytical and organizational skill

• The ability to prioritize work demands and meet deadlines

• Proficiency in PC-based word processing and database documentation (Word, Excel, Internet, Outlook)

• Ability to meet regulatory deadlines

• Experience in workforce development and resource management with excellent team building and professional development skills

• Medicare and Medicaid experience

• Managed care experience

• Experience  in geriatric special needs, behavioral health, home health

• Understanding of the importance of cultural competency in addressing targeted populations.

• Experience with electronic documentation system(s)

• Experience with cost neutrality and budgeting

Language (Other than English):

None

Travel Requirement:

0% - 25%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

Office-based

Teaches / trains others regularly

Occasionally

Travel regularly from the office to various work sites or from site-to-site

Rarely

Works primarily out-of-the office selling products/services (sales employees)

Never

Physical work site required

Yes

Lifting: up to 10 pounds

Constantly

Lifting: 10 to 25 pounds

Occasionally

Lifting: 25 to 50 pounds

Rarely

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times.  In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. 

Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Pay Range Minimum:

Pay Range Maximum:

Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations.  The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.

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