Manager, Case Management - Integrated Care - MyCare Institutional - Ohio

Job Summary:The Manager, Case Management - Integrated Care is responsible for overseeing the Integrated Care Duals Product Teams in coordinating the care, service and health benefits for selected member populations.Essential Functions:Monitors and promotes safe and effective utilization of healthcare resources through clinical variance and benefits managementActively manages the performance of the Integrated Care Management Liaisons and internal/external Care Management teams to ensure safe and effective service delivery, quality outcomes, and compliance with all state and accreditation requirementsAssist in verifying eligibility, previous enrollment history, demographics and current health status of each member as appropriateAudit and review documentation gathered by internal staff and external partners to ensure thoroughness, accuracy and care management competencyContribute to the ongoing review of Member care plans, defining specific issues, goals and interventions as appropriateResponsible for ensuring that member/CM caseload ratios are kept at optimal levelsEnsures that CM teams monitor and evaluate care plan effectiveness on an ongoing basis through member, family, provider, and stakeholder contactMay assist Member liaisons in the facilitation and coordination of services based upon the care treatment plan developed in collaboration with all stakeholdersWorking with peer Managers and Director, responsible for overall day-to-day Care Center operations, team coordination, and member outcomes, including, new staff orientation and scheduling, training, in-servicing, quality and performance improvement, regulatory and contractual complianceOversees effective care planning and implementation meeting member needsOversees the coordination of services with community partners to maximize utilization of appropriate community resources and supports, and assure effective and appropriate transitions between settings of careWorks with Incident Management staff in the review and investigation of member incidents and/or issues related to member health and safetyWorks with Community Partners, Provider Relations and Network Management staff in the ongoing monitoring of quality issues for network providersMonitoring of scheduling/work allocation and productivityProvides quality monitoring and conducts regularly scheduled one-on-one meetings with all team membersWorks with corporate staff in the follow up and review of member complaints and grievancesMonitor and analyze Integrated Care Management data and reportingAssures overall compliance with the Integrated Care product model of careOversee and/or maintain current and accurate documentation of contacts, care treatment plans, case notes, referrals, and assessments in Care Management electronic record and within protocols and guidelines of the Care Management programActively oversee the performance of the Integrated Care Management teams to ensure all state and accreditation requirements are achievedReview and update all Care Management policies and Standard Operating ProceduresMay participate in meetings with providers to inform them of Care Management services and benefits available to membersServe as interdepartmental liaison and network with other departments to gather/share information about issues related to the Care Management processMay assist in education of member/caregiver regarding healthcare access and benefits, and provide member/caregiver with health education and wellness materialsPrecept and/or mentor new staffProvide ongoing training, mentoring, coaching and disciplinary action as neededParticipate in the hiring process of new Integrated Care Management personnelProvide guidance/instruction for Integrated Care Team Leads and other staff via formal and informal meetingsRegular travel to conduct member visits, provider visits and community based visits as needed to ensure effective administration of the programPerform any other job duties as requestedEducation and Experience:Bachelor’s Degree in Nursing, healthcare field, business administration or related field or equivalent years of relevant work experience requiredMinimum of five (5) years or more of clinical experience is requiredMinimum of three (3) years Medicaid and/or Medicare managed care or HCSB Waiver case management experience is preferredThree (3) years as a case manager is preferredTwo (2) years of management experience is preferredCompetencies, Knowledge and Skills:Intermediate proficiency level of Microsoft Outlook, Word and ExcelAbility to operate smart phone, iPad, or other mobile communication devices to ensure productivity and ability to perform essential functionsAbility to communicate effectively with a very diverse group of individualsAbility to multi-task and work independently within a team environmentAbility to collaborate with and effectively lead other team members to optimize outcomes for membersFamiliarity of the state and federal healthcare regulations and environmentAwareness of community and state support resources for population servedCritical listening and thinking skillsDecision making and problem solving skillsProper grammar usageStrong organizational and time management skillsProper phone etiquetteCustomer service orientedTraining/teaching skillsManagement and prior supervisory skillsLicensure and Certification:Current, unrestricted license in the state of Ohio as a Registered Nurse (RN), Licensed Independent Social Worker (LISW), Psychologist, or Licensed Professional Clinical Counselor (LPCC)Case Management certification is preferredEmployment in this position is conditional pending successful clearance of a driver’s license record check. If the driver’s license record results are unacceptable, the offer will be withdrawn or, if you have started employment in this position, your employment in this position will be terminatedTo help protect our employees, members, and the communities we serve from acquiring communicable diseases, Influenza vaccination is a requirement of this position. CareSource requires annual proof of Influenza vaccination for designated positions during Influenza season (October 1 – March 31) as a condition of continued employment. Employees hired during Influenza season will have thirty (30) days from their hire date to complete the required vaccination and have record of immunization verified.CareSource adheres to all federal, state, and local regulations. CareSource provides reasonable accommodations to qualified individuals with disabilities or medical conditions, sincerely held religious beliefs, or as required by state law to enable the employee to perform the essential functions of the position. Request for accommodations will be completed through an interactive review process.Working Conditions:Mobile Worker: This is a mobile position, meaning that regular travel to different work locations is essential. Will be exposed to weather conditions typical of the location and may be required to stand and/or sit for long periods of timeReside in the same territory they are assigned to work in; exceptions may be considered, due to business needMay be required to travel greater than 50% of time to perform work duties. A valid driver’s license, car, and insurance are necessary for work related travelRequired to use general office equipment, such as a telephone, photocopier, fax machine, and personal computerFlexible hours, including possible evenings and/or weekends as needed to serve the needs of our member and may refer members to other CareSource resourcesCompensation Range:$83,000.00 - $132,800.00CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.Compensation Type (hourly/salary):SalaryOrganization Level CompetenciesFostering a Collaborative Workplace CultureCultivate PartnershipsDevelop Self and OthersDrive ExecutionInfluence OthersPursue Personal ExcellenceUnderstand the BusinessThis job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.#LI-JM1Brand=CareSource #J-18808-Ljbffr