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

About the role

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.

Responsibilities

• Monitors and promotes safe and effective utilization of healthcare resources through clinical variance and benefits management
• Actively 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 requirements
• Assist in verifying eligibility, previous enrollment history, demographics and current health status of each member as appropriate
• Audit and review documentation gathered by internal staff and external partners to ensure thoroughness, accuracy and care management competency
• Contribute to the ongoing review of Member care plans, defining specific issues, goals and interventions as appropriate
• Responsible for ensuring that member/CM caseload ratios are kept at optimal levels
• Ensures that CM teams monitor and evaluate care plan effectiveness on an ongoing basis through member, family, provider, and stakeholder contact
• May assist Member liaisons in the facilitation and coordination of services based upon the care treatment plan developed in collaboration with all stakeholders
• Working 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 compliance
• Oversees effective care planning and implementation meeting member needs
• Oversees 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 care
• Works with Incident Management staff in the review and investigation of member incidents and/or issues related to member health and safety
• Works with Community Partners, Provider Relations and Network Management staff in the ongoing monitoring of quality issues for network providers
• Monitoring of scheduling/work allocation and productivity
• Provides quality monitoring and conducts regularly scheduled one-on-one meetings with all team members
• Works with corporate staff in the follow up and review of member complaints and grievances
• Monitor and analyze Integrated Care Management data and reporting
• Assures overall compliance with the Integrated Care product model of care
• Oversee 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 program
• Actively oversee the performance of the Integrated Care Management teams to ensure all state and accreditation requirements are achieved
• Review and update all Care Management policies and Standard Operating Procedures
• May participate in meetings with providers to inform them of Care Management services and benefits available to members
• Serve as interdepartmental liaison and network with other departments to gather/share information about issues related to the Care Management process
• May assist in education of member/caregiver regarding healthcare access and benefits, and provide member/caregiver with health education and wellness materials
• Precept and/or mentor new staff
• Provide ongoing training, mentoring, coaching and disciplinary action as needed
• Participate in the hiring process of new Integrated Care Management personnel
• Provide guidance/instruction for Integrated Care Team Leads and other staff via formal and informal meetings
• Regular travel to conduct member visits, provider visits and community based visits as needed to ensure effective administration of the program
• Perform any other job duties as requested

Requirements

• Bachelor’s Degree in Nursing, healthcare field, business administration or related field or equivalent years of relevant work experience required
• Minimum of five (5) years or more of clinical experience required
• Minimum of three (3) years Medicaid and/or Medicare managed care or HCSB Waiver case management experience preferred
• Three (3) years as a case manager preferred
• Two (2) years of management experience preferred
• 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 preferred
• Employment conditional pending successful clearance of a driver’s license record check; unacceptable results will result in offer withdrawal or termination
• Annual proof of Influenza vaccination required during Influenza season (October 1 – March 31) as a condition of continued employment; new hires during season have 30 days to comply

Skills

• Intermediate proficiency level of Microsoft Outlook, Word and Excel
• Ability to operate smart phone, iPad, or other mobile communication devices to ensure productivity and ability to perform essential functions
• Ability to communicate effectively with a very diverse group of individuals
• Ability to multi-task and work independently within a team environment
• Ability to collaborate with and effectively lead other team members to optimize outcomes for members
• Familiarity of the state and federal healthcare regulations and environment
• Awareness of community and state support resources for population served
• Critical listening and thinking skills
• Decision making and problem solving skills
• Proper grammar usage
• Strong organizational and time management skills
• Proper phone etiquette
• Customer service oriented
• Training/teaching skills
• Management and prior supervisory skills
• Fostering a Collaborative Workplace Culture
• Cultivate Partnerships
• Develop Self and Others
• Drive Execution
• Influence Others
• Pursue Personal Excellence
• Understand the Business

Schedule

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 time. Must reside in the same territory they are assigned to work in; exceptions may be considered due to business need. May 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 travel. Required to use general office equipment, such as a telephone, photocopier, fax machine, and personal computer. Flexible hours, including possible evenings and/or weekends as needed to serve the needs of our members and may refer members to other CareSource resources.

Pay

$83,000.00 - $132,800.00. CareSource 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.

Benef