The Manager of Care Management is responsible for managing the day-to-day operation of the Care Management teams including hiring, scheduling, coaching, development and evaluation of employee performance. Positions reporting to the manager include, Nurse Care Clinicians, Social Workers, Community Health Workers and Care Coordinators. The manager will develop, monitor and revise workflow operations to ensure team and department efficiency and will analyze available data to measure individual and team performance, and department. Working with his or her staff, the manager will recommend and assist in the development and implementation of policies and procedures that integrate state, federal and national accreditation regulations to ensure compliance. The manager will oversee the training of the staff and work collaboratively with the clinical trainer to develop team and individual staff level orientation, skill building and educational programs for the team and the department. The manager will actively participate as a member and / or lead on internal departmental, divisional and or corporate committees and in conjunction with the Director of Care Management will assume responsibility  for critical tasks including the management of one or more focused clinical initiatives.

KEY FUNCTIONS/RESPONSIBILITIES:

• Directs and manages all operational and management activities of the Care Management teams including the development and implementation of effective metrics to monitor productivity,  development of workflows and job aids and management of clinical and non-clinical staff as well as facilitation of team meetings.

• Directs the distribution of work among assigned staff and ensures members with most actionable interventions are assigned for outreach and engagement.

• Utilizes operational reports to ensure individual, team and department metrics are met and makes operational corrections as necessary. Monitors changes for improved outcomes.

• Monitors staff performance on a regular basis through audits, operational reports and metrics and provides timely feedback and implements corrective actions plans as needed.

  • Conducts weekly team meetings, clinical rounds, and 1-1 mentoring of all staff.

• Identifies areas for improvement of existing operational policies and procedures and develops recommendations for the Director of Care Management. 

• Hires staff for allocated positions.

• Oversees the analysis, development, implementation and evaluation of the care management program and policies so that quality, documentation, policies and procedures are consistent with current federal and state regulations and applicable accreditation standards (e.g. NCQA).

• Works closely with all appropriate internal departments and community based organizations/partners  to resolve complex issues related to the medical and social  case management of members. Acts as a liaison to the Legal Compliance and Quality Departments.

• Other functions as required to support departmental activities.

QUALIFICATIONS: 

EDUCATION:

• Bachelors Degree in Nursing or Bachelors Degree with Nursing School degree or equivalent relevant work experience. 
• CCM certification desired.
• Bachelors or Masters Degree in Nursing or related field preferred.

EXPERIENCE:

• 3 years prior management experience. 
• 10 years clinical experience including acute care and care management or discharge planning in an acute care or health insurance environment or home care.
• Experience with Medicaid recipients and community services preferred. 
• Experience with  electronic healthcare applications preferred.

CERTIFICATION OR CONDITIONS OF EMPLOYMENT: _ _

• Current state licensure as a Registered Nurse.
• Certification in Case Management preferred.

COMPETENCIES, SKILLS, AND ATTRIBUTES:

• Understands health care delivery to diverse patient populations.
• Demonstrated commitment to excellent customer service.
• Intermediate skill level with Microsoft Word, Excel, Visio and PowerPoint.
• Effective collaborative and proven process improvement skills.
• Strong oral and written communication skills; ability to interact within all levels of the organization as well as with external contacts.

*Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status.

Required Skills Required Experience

Knowledge of:

• Local, state and federal guidelines relative to disadvantaged business enterprise.
• DBE environment in the metropolitan area.
• EEO/AA principles and practices.
• Procurement procedures and terminology.
• Business accounting systems and cost accounting principles.
• Business terminology and financial mathematical principles.
• Principles and techniques of supervision, training, and general administration.
• Computer applications pertaining to procurement and business requirements including computerized data organization, retrieval and analysis.
• Current technology and trends in the profession.

Skills and Abilities to:  

• Plan, direct, and coordinate the activities of department staff.
• Represent the Agency to private industry, community, and government representative’s.
• Formulate and administer Agency policy and procedures.
• Analyze complex problems and data and logically identify solutions.
• Provide technical consultation, guidance, and direction to Agency departments on DBE and contractor workforce issues.
• Establish and maintain effective relations with private vendors, organizations, and federal/state contracting regulators.
• Interview, select, train, assign, and evaluate the work of subordinate personnel.
• Establish work standards and performance guidelines.
• Provide formal classroom training and instruction related to DBE and contractor workforce.
• Prepare and give public presentations on the Agency's activities, functions and issues.
• Maintain mental capacity, which allows the capability of making sound decisions and demonstrating intellectual capacities.
• Communicate effectively orally and in writing with a variety of individuals representing diverse cultures and backgrounds.
• Establishes effective working relationships with management, employees, employee representatives and the public.
• Treat Agency employees, representatives of outside agencies and members of the public with courtesy and respect.
• Function calmly in situations which require a high degree of sensitivity, tact and diplomacy.