Population Health Care Manager- Team Lead Medicaid

Population Health Care Management Team Lead

The Care Management Team Lead is a role developed to work in coordination with the PHMO leadership in an assigned program to ensure that the work of care management staff is accomplished effectively. Responsible for supervision of assigned team that includes productivity, performance and quality of assigned team. In collaboration with the managers, identifies plans and executes activities to promote effective quality care management and to ensure compliance according to policies and procedures. Additionally, may be assigned a small percentage of a caseload/portfolio to ensure the ability to engage customers within an identified population. Model for staff best-in-class care management by using practical experience engaging the identified customers.

General Description of the Job Class

The Team Lead may be responsible for additional responsibilities above their respective general job class that they are leading. The Team Lead is responsible for clinical/functional expertise for specific customer populations (QA/QI, Engagement/Referral Process, Clinical conditions, Education/Training, and Care Management) with a design to meet specific contractual and program related requirements. The role functions as an integral part of an interdisciplinary team, ensuring excellence with transitions of care to achieve optimal clinical outcomes through a seamless model of access and care.

Duties and Responsibilities of this Level

• Coordinate and facilitate timely implementation of appropriate interventions for identified customer populations following established policies and procedures. Or making necessary recommendations when gaps to policies and procedures are identified.
• Monitor, support, and engage both staff and additional management in related systemic opportunities, strengths, and benchmarks that will enhance negotiations with payers, improve care management, and/or address gaps in care. Using accessible data from multiple sources to ensure appropriate outreach, education, and necessary interventions are identified.
• Participation in the hiring/firing process of staff across care management.
• Engage with direct reports on a monthly basis via monthly individual supervision and larger team meetings to provide timely departmental updates, training, and coaching. Provide information on staff productivity on a monthly basis, at minimum.
• Shadow each direct report at least once per evaluation period unless concerns are identified and more is required.
• Conduct one-on-one training and group training with team members for identified areas of need related to workflow, documentation, and/or patient care.
• Manage time and attendance for staff members in API system.
• Complete routine audits (in data management system, MaestroCare/Virtual Health, and recorded calls) for quality, clinical care, understanding of education provided, accuracy of process, and overall experience of any PHMO customers. Provide timely and accurate oversight of process and feedback loops.
• Participates in identified PHMO/DukeWELL meetings, and role enhancing trainings that are health system/state/regional/nationally appropriate, etc.
• Develop and maintain positive relationships with customers internal and external to Duke Health System.
• Maintain small caseload/patient-level responsibilities, following identified workflow and meeting required timeframes for completion of documentation, assessment, medication reconciliation and care planning.

Required Qualifications at this Level

Bachelor's degree in a clinical field such as Nursing, Counseling, Social Work, Therapy, Allied Health, or community health related fields.

3 years of clinical experience required.

Extensive management experience

Care/Case management experience within different settings i.e. Home Health, Community, Gen. Med

Strategic Planning experience

Must have a current license in at least one of these areas: current or compact RN licensure in the state of North Carolina

Current licensure as a licensed clinical social worker by the NC Social Work Certification and Licensure Board, current licensure as a Licensed

Professional Counselor by the state of NC

Current licensure as a Licensed Addiction Specialist by the state of North Carolina.

Requires ACM or CCM certification within 3 years of hire date or by December 31, 2020