The Supervisor is responsible for planning, organizing, developing and implementing the principles, programs, policies and procedures employed in the delivery of long term care services and support to members in the community and institutionalized settings. The Supervisor is responsible for the management of the day-to-day operational activities for LTSS Programs: Long Term Care (LTC), Community Based Adult Services (CBAS), and In-Home Support Services programs and personnel, while interacting with internal/external management staff, providers, vendors, health networks and other internal and external customers in a professional, positive and competent manner. The position's primary responsibilities are the supervision and monitoring of the ongoing and daily activities of the department’s staff. In addition, the supervisor will be resolving members' and providers' issues and barriers ensuring excellent customer service. The supervisor will manage staff coverage in all areas of LTSS to complete all assignments, the orienting and training of new employees, and ensure contractual and regulatory requirements are met.
POSITION RESPONSIBILITIES:
- Supervises, trains and audits the LTSS Medical Case Managers, Social Workers, Program Specialists, and non-clinical staff such as Personal Care Coordinators (PCC), Medication Authorization Assistants (MAA), and Administrative Assistants (AA) per Medi-Cal processing guidelines.
- Serves as a resource to departmental and organizational staff which includes internal departments and affiliated health networks, regarding authorization rules and processes.
- Manages the day-to-day activities of the department to ensure compliance with company policies and regulatory requirements.
- Attends all LTSS required meetings, Concurrent Review and/or Case Management clinical rounds, and other meetings including as internal and external interdisciplinary care team meetings as needed or assigned.
- Makes staffing assignments and recommendations based on authorization priority, overall workload, and staffing needs per program to ensure daily workloads are fulfilled with a cost-effective use of resources and time.
- Conducts audits as assigned by LTSS management team as required by Policy and Procedure. This includes auditing for quantity and quality of work completed, and timeliness required by regulations.
- Provides ongoing/periodic in-service training for all staff based on audit findings and facilitates the ongoing development and education of staff. Provides assistance in the development and implementation of policies and procedures, as well as orientation.
- Trains, evaluates, and provides performance feedback to staff as necessary including: Day to Day coaching and performance feedback to individuals, annual and 90-Day appraisals, and Performance Improvement Plans based on individual needs; involves HR as necessary.
- Identifies areas of improvement in workflows and assists in the creation of desktop procedures and new workflows for corrective action. Assists with education of the LTSS staff on new/revised workflow processes.
- Assists the Manager of LTSS in all areas of the department, as requested, to ensure departmental and organizational goals are met. This includes a requirement to be able to complete authorization approvals for both the CBAS and LTC Programs.
- Works with the IS and Reporting Departments to support them in the creation of reports that ensures monitoring and reporting LTSS program activities to regulatory agencies as required by the organization and regulatory entities.
- Establishes and maintains effective working relationships with public and private agencies providing long term support services to members, including assisting Health Networks and other departments to minimize barriers to discharge planning.
- Resolves provider/vendor/member problems related to the delivery of LTSS.
- Other projects and duties as assigned.
Required Skills
- Supervise staff by monitoring, coaching and teaching, and working with staff through Performance Improvement Plans.
- Maintain and ensure confidentiality of patient and employee information personally and professionally.
- Establish and maintain effective working relationships with all levels of staff, other departments, programs and agencies.
- Identify problems, critically analyze and recommend solutions quickly while integrating concepts into new or existing workflows.
- Meet deadlines, take initiative and assume responsibility while multi-tasking a variety of projects.
- Utilize clinical judgment, independent analysis, and evidenced-based clinical guidelines in decision making.
- Communicate in a clear and concise manner, both verbally and in writing, with personnel at all levels of the organization and with contacts within the community, state, and federal agencies.
- Resolve any escalations or situations as they occur while maintaining a professional demeanor in all aspects of the work environment, including attendance and a willingness to learn and grow in the role.
- Travel outside of CalOptima as needed to Nursing Facilities and CBAS sites.
- Utilize and access computer and appropriate software (e.g. Microsoft Office: Word, Excel, Access, PowerPoint) and job-specific applications/systems (e.g. Altruista GuidingCare, Facets, Cerecons) to produce correspondence, charts, spreadsheets, and/or other information applicable to the position.
Required Experience
EXPERIENCE & EDUCATION:
- Current, unrestricted RN license to practice in the State of California is required.
- Bachelor’s degree in Nursing or equivalent work experience is required.
- 3 years of managed care experience at a health plan or medical group, or skilled nursing facilities or related work experience is required
- 2 years of experience in dealing with seniors and persons with disabilities required.
- 2 years of supervisory and/or lead experience preferred.
- Valid driver’s license and vehicle, or other approved means of transportation, an acceptable driving record, and current auto insurance will be required for work away from the primary office approximately 30% to 50% of the time required.
KNOWLEDGE OF:
- Detailed knowledge of departmental procedures, policies, clinical guidelines, Medicare & Medi-Cal guidelines, with experience in applying these guidelines to skilled nursing facilities, all levels of care at nursing facilities, In-Home Supportive Services and Community Based Adult Services programs.
- Title 22, DHCS, DMHC, CMS and NCQA standards.
- Supervisory skills appropriate to managing clinical and clerical staff.
- Detailed knowledge of departmental procedures, policies, and clinical guidelines.
- Appropriate strategies to serve diverse social and ethnic groups.
- Benefit interpretation and administration of appropriate medical necessity guidelines.
Grade: N
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