Care Manager Supervisor FT

Job Overview: The role of the Care Manager Supervisor is to provide supervision and direction to the Care Managers to ensure the delivery of high quality, person-centered Care Management, while meeting all regulatory and TCC requirements.

To apply for a CMS position please ensure you have taken the CM Promotional examination within the last year and received a passing score. To sign up for the exam please sign up through Absorb or contact the Training Department at View email address on talent.com

Please submit your application with a cover letter and up to date resume as required for this role.

Essential Responsibilities:

• Maintains professional standards while fostering a positive and supportive work environment that promotes a healthy balance, encourages growth, recognizes

achievements, and prioritizes open communication to help staff thrive and excel.

• Provide leadership and oversight to the assigned Care Managers, ensuring they meet organizational standards and objectives in line with TCCs mission statement.

• Conduct weekly one-on-one supervision meetings with staff to provide guidance, support, and performance feedback, ensuring alignment with organizational goals.

• Ensure that Care Managers are engaging individuals, representatives and providers through contacts and visits at the required quality cadence, as well as monitoring reasons for no services/ no contact established.

• Provide oversight on all aspects of monthly service delivery, including successful and unsuccessful contacts, ensuring accurate and contemporaneous face to face visits and the completion of the monthly checklists.

• Ensure Care Managers comply with the required timeframes for delivery of service to new enrollees and monitor their assignments to ensure timely adherence to guidelines.

• Monitor the regulatory timelines for conducting and finalizing life plans appropriately and follow up on life plans not finalized and/or semiannual life plans not held.

• Assist with Life Plan provider disputes by facilitating discussions between the CM, individuals and provider agency and escalate as needed.

• Address and follow-up on escalated complaints /grievances from individuals/Families.

• Oversee the follow up of pertinent regulatory documents, including but not limited to, LCED’s, DDP2’s, etc.

• Monitor and analyze reasons for disenrollment of individuals, identifying trends and patterns while focusing on individual retention efforts by addressing their needs, enhancing satisfaction and following strategies to improve overall engagement and outcomes.

• Monitor Care Managers’ caseloads and reassignments as applicable, per Tri-County Care’s established ratios and geographic proximity standards.

• Responsible to provide oversight of the individuals who have been risk stratified as high or medium need as well as the specific review of individuals with potential SDOH (social determinants of health) needs.

• Ensure active Medicaid status for individuals by monitoring eligibility and addressing Medicaid-related concerns in a timely and accurate manner.

• Monitor individuals’ OPWDD eligibility status and assist with eligibility status updates.

• Ensure collaboration with the Clinical team and participation in meetings regarding complex cases and follow up on recommendations.

• Ensure QA audit corrections are responded to and completed accurately by CMs in a timely manner.

• Collaborate closely with the resource team to provide resources to individuals, ensuring coordinated care and the alignment of resources to meet the unique needs of each individual.

• Ensure timely follow up and clear communication with the incident management team to provide updates, escalate issues, and report potentially reportable incidents to ensure immediate and ongoing health and safety concerns are addressed.

• Ensure Care Managers effectively utilize the Reportal as a key tool for monitoring and tracking their caseloads, while encouraging independent ownership of their workload and fostering a proactive initiative-driven approach to care management.

• Participate in the hiring process of new Care Management hires.

• Collaboration with the CMT and HR teams for monitoring and completing KPI’s, 90-day and annual performance reviews.

• Collaboration with the HR department to address employee performance concerns, as needed, as well as ensure TCC HR policies are being followed, including but not limited to; PTO requirements, overtime requests, status change requests, etc.

• Review and approve bi-weekly time and attendance cards to ensure accuracy, compliance with company policies, and adherence to payroll deadlines.

• Works collaboratively with other CMSs and RDs within Tri-County Care.

• Provide updates to the RD on a regular basis and actively communicate issues or challenges that arise.

• Ensure timely responses to all inquiries and requests, with a commitment to addressing and resolving issues within 24 hours to maintain efficient operations and employee/individual satisfaction.

• Acts as the liaison with the respective OPWDD regional office and address escalated issues, i.e. Waiver services approval, crisis cases, special POPs, etc.

• Actively lead bi-weekly team meetings, or more often, as necessary, to ensure quality service delivery related to all aspects of the care management role.

• Actively participate in all required internal and external meetings, including but not limited to monthly supervisor meetings, CSIDD, etc.

• Ensure that the Care Managers participate in mandatory webinars and training sessions, including SLMS trainings, and maintain compliance with TCC policies specifically related to training requirements.

• Ensure compliance with all OPWDD regulations and Tri-County Care policies and quality standards.

• Maintain an up-to-date Outlook calendar to accurately reflect work-related meetings, appointments, and availability.

• Take lead and ownership of assigned tasks and special projects within their respective teams and assist with coverage needs as needed.

• Any other responsibilities as deemed necessary by the RD or VP of CM.

Specific Knowledge, Skills and Abilities:

• Excellent organizational skills and the ability to attend to details and meet deadlines

• Computer software skills

• Knowledge of CCO/HH Provider Policy Guidance and Manual

• Effective management skills with ability to set priorities and objectives

• Ability to plan, direct, and review the work of others

Preferred Education, Experience and Licenses:

• A Bachelor’s degree with two years of relevant experience, OR

• A License as a Registered Nurse with two years or relevant experience, which can include any employment experience and is not limited to case management/service coordination duties, OR

• A Master’s degree with one year of relevant experience

• MSC Service Coordinator Supervisors prior to July 1, 2018 are “grandfathered” to facilitate continuity of care

• Please Note, when reviewing applicants the following is reviewed prior to an interview being considered:

  Last six months’ billing historyQA review of case notes/life plans/overall workReview of personnel fileCM Promotional Examination Score reviewResume ReviewMinimal 1 year experience at TCC as a Care Manager