Manager Case Management

Manager, EligibilityUnder the direction of the Director, the Manager works together with Eligibility RNs, Business Development Representatives and Enrollment Representatives in order to determine the eligibility of future participants for the InnovAge PACE Program. Physical attendance at an InnovAge facility and/or an InnovAge participant home is essential to performing the job duties.Functional Category: Management AdministrationEstimated Percent of time Spent – 70%Works closely with the Sales and Enrollment team to determine if prospective PACE participants meet required eligibility standards for all PACE participants.Oversees services related to home visits and/or center-based clinic appointments, to make level of care assessments to determine eligibility.Oversees completion of eligibility referral documents and completion of supporting documentation for application to the State for enrollment of potential PACE participant.Works closely with individual state Medicaid Departments and sales and enrollment teams to make eligibility decisions about prospective new PACE participants.Supports business development and census growth process by collaborating with Sales and Enrollment department, Participates and assists with outreach programs as requested and appropriateServe as member of the Interdisciplinary Team (IDT), and coordinate appointments for prospects that require further assessments by other IDT members.Participates in the case management of peer review of client records and provides consultation to case managers and other staff members regarding medical and nursing issues.Maintain knowledge and expertise in eligibility, enrollment, and program specifications for the Federal and State health coverage programs Medicare and Medicaid, and specifically as those guidelines apply to the Program of All Inclusive Care for the Elderly (PACE).Shares responsibility with other team members in the implementation of PACE philosophy and achievement of program goals.Functional Category: SupervisionEstimated Percent of time Spent – 30%Effectively supervises and manages direct reports and provides, by example and leadership, motivation and direction to employees of the organization.Oversees locally based Eligibility RNs who complete in home and phone-based eligibility assessments of potential PACE participants.Monitors, manages, and continually improves Eligibility RN scheduling, productivity, assessments, presentation of information within IDT & HSD meetings within respective centers.Carries out supervisory responsibilities in accordance with the organization's policies and applicable state and federal employment laws.Responsibilities include interviewing, hiring, and training employees; planning, assigning, and directing work; appraising performance; recognizing and rewarding employees; corrective disciplinary procedures and practices (under direction of supervisor and in partnership with Human Resources), addressing complaints and resolving problems.Ensures annual employee performance reviews are conducted in a timely and effective manner. Evaluates performance of employees for compliance with established policies and objectives of the organization and contributions in attaining objectives.Helps set the tone of the department to ensure morale, team work, and that the positive employment culture of the organization is maintained.Regularly schedules leadership/management, department, and staff 1:1 meetings to provide leadership, development, and a forum for communication to ensure coordination and collaboration in meeting organization and individual goals.Travel RequirementsTravelTravel requiredOvernight travel out of stateQualificationsTo perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.RequiredEducationAssociates degree from accredited nursing school requiredCurrent Registered Nurses License in state in which workingCurrent First Aid and BLS certifications are required prior to hire . Acceptable vendors for certifications are from either American Heart Association and/or American Red Cross.Work Experience and Qualifications8+ years health care experience with emphasis in geriatrics1+ year working with the frail or elderly