Case Management Supervisor - Medicare/DSNP

About the role

Provides clinical and administrative leadership to care management team(s). Responsible for direct daily oversight of both medical and behavioral health clinicians and non-clinical staff in the delivery of care management services to identified Plan members with a range of physical health, behavioral health and social service needs. Implements care management programs and ensures program operations and documentation support regulatory standards.

Responsibilities

• Prioritizes daily workflows, assignments and triage priorities to meet state and Federal regulatory requirements and established organizational performance metrics.
• Maintains performance and productivity of team and team members to ensure guidelines are followed and goals are met.
• Facilitates collaboration with internal partners for a coordinated approach to care coordination for members.
• Supports regionalized care team structure to coordinate care across IMC regions.
• Responsible for a strong understanding of health plan benefits for assigned line(s) of business.
• Participates in Care Management Rounds to support a productive and collaborative discussion and provide clinical input on cases.
• Conducts staff audits according to internal policies and procedures in order to identify opportunities for improvement and alignment with program expectations.
• Aids in the development of team metrics; implements workflows to achieve assigned metrics. Utilizes data to monitor clinician productivity.
• Aids management in the identification, implementation, and maintenance of standardized operations to ensure compliance standards are met.
• Works with management to establish efficiency and quality standards for the team; conducts routine audits and uses data to drive performance improvement.
• Reviews quality audits and shares results with associates in a timely manner; provides education and coaching to improve performance as needed.
• Ensures that staff are adequately trained to achieve goals and outcomes for the program. This includes onboarding new staff and ongoing training for existing staff. Assists in performing direct member outreach and care management activities as needed to support staff and the team.

Requirements

• Minimum of three (3) years clinical experience in an acute care or public health setting, AND a minimum of three (3) years as a case manager in a Accountable Care Organization (ACO), Managed Care Organization (MCO), or Behavioral Health Organization (BHO) required, AND three (3) years supervisory or leadership experience in a healthcare or managed care setting preferred.
• Bachelor’s degree in nursing or a master’s degree in social work and/or a related behavior health field.
• A current, unrestricted RN license in the State of Washington OR a current, unrestricted LICSW license in the State of Washington.
• Current, unrestricted Case Management Certification within the first two (2) years of employment.
• Experience with Microsoft Office applications such as Outlook, Word, and Excel.

Skills

• Ability to set performance expectations, coach for performance success, and achieve department and company objectives.
• Knowledge of substance abuse recovery and mental health care models.
• Knowledge of Washington state Medicaid requirements, CMS Medicare care management, and special needs plan (SNP) requirements.
• Verbal and written communication skills.
• Organizational and time management skills.
• Knowledge of regulatory and certification requirements and their impact on the organization such as Healthcare Effectiveness Data and Information Set (HEDIS), Consumer Assessment of Healthcare Providers & Systems (CAHPS), and National Committee for Quality Assurance (NCQA).
• Knowledge of criteria set, including Milliman and InterQual.
• Ability to work well in a team environment and maintain confidentiality.