Manager Integrated Care Management

Role Overview

The Manager, Integrated Care Management, leads the day-to-day operations of the Integrated Care Management team, overseeing the development, implementation, and performance of clinical care management programs.

Responsibilities

• Plans, organizes, and directs the development and implementation of clinical care management programs.
• Ensures staff are adequately trained, oriented, and provided with regular professional development.
• Identifies opportunities for improvement, both clinical and administrative, and assists the Director in strategic planning.
• Captures the intake process for the new Care Management program and determines impacts, timelines, savings, etc.
• Coordinates the development of recommended policies.
• Coordinates, establishes, and monitors achievement of departmental goals and objectives.
• Collaborates with lines of business to ensure care management programs comply with all National Committee for Quality Assurance (NCQA) compliance standards and comply with all applicable state and federal laws.
• Directs the effectiveness of existing programs and services.
• Identifies and evaluates new programs and services to address cost-effectiveness, proposed process improvements, and compliance with NCQA and State-incentivized health outcomes.
• Participates in and supports the corporate Medical Management Strategy.
• Maintains oversight of monthly financial statements for the area of responsibility to determine and recommend adjustments.
• Manages contractual compliance and regulatory requirements and reporting.
• Facilitates effective communication both within and between departments to exchange information about quality of care, member concerns, and cost-efficient services.

Requirements

• Bachelor’s degree in nursing or a related healthcare field required.
• Unrestricted licensed Registered Nurse (RN) in MI license.
• Master’s degree in social work with a current, unrestricted MI LMSW or LCSW license.
• 8 to 10 years of progressive healthcare or managed care experience.
• 5 years of leadership or case management leadership.
• 1 year of project management experience required.
• Experience managing clinical operations, including budgeting, staffing models, and change management.
• Designation of Certified Case Manager is preferred.