Manager, Case Management RN- Integrated Care

Oversee the Integrated Care Duals Product Teams in coordinating care, service, and health benefits for selected member populations.

Responsibilities

• Monitor and promote safe and effective utilization of healthcare resources through clinical variance and benefits management.
• Actively manage the performance of 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.
• Ensure that member/CM caseload ratios are kept at optimal levels.
• Ensure 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.
• Work with peer managers and director to oversee overall day-to-day Care Center operations, team coordination, and member outcomes, including new staff orientation, scheduling, training, in-servicing, quality and performance improvement, regulatory and contractual compliance.
• Oversee effective care planning and implementation to meet member needs.
• Coordinate services with community partners to maximize utilization of appropriate community resources and supports, and ensure effective and appropriate transitions between settings of care.
• Work with Incident Management staff in the review and investigation of member incidents and/or issues related to member health and safety.
• Collaborate with Community Partners, Provider Relations, and Network Management staff in the ongoing monitoring of quality issues for network providers.
• Monitor scheduling, work allocation, and productivity.
• Provide quality monitoring and conduct regularly scheduled one-on-one meetings with all team members.
• Work with corporate staff in the follow-up and review of member complaints and grievances.
• Monitor and analyze Integrated Care Management data and reporting.
• Ensure 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 the Care Management electronic record 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 an interdepartmental liaison and network with other departments to gather/share information about issues related to the Care Management process.
• May assist in the education of members/caregivers regarding healthcare access and benefits, and provide 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.
• Travel regularly 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.
• Minimum of five (5) years of clinical experience.
• Minimum of three (3) years of 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 in this position is conditional pending successful clearance of a driver’s license record check. If the driver’s license record results are unacceptable, the offer will be withdrawn or, if you have started employment, your employment will be terminated.
• Annual proof of Influenza vaccination for designated positions during Influenza season (October 1 – March 31) as a condition of continued employment.

Skills

• Intermediate proficiency in Microsoft Outlook, Word, and Excel.
• Ability to operate a smartphone, iPad, or other mobile communication devices to ensure productivity and perform essential functions.
• Ability to communicate effectively with a 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 with state and federal healthcare regulations and environment.
• Awareness of community and state support resources for the 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 orientation.
• Training/teaching skills.
• Management and prior supervisory skills.

Pay

$74,700.00 - $119,520.00 annually. CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, 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.

Benefits

We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Schedule

• Mobile Worker: 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 assigned to work in; exceptions may be considered due to business need.
• May be required to travel greater than 50% of the 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.