Medicare Integrated Care Management Supervisor (RN or LCSW)

General Description

The Supervisor, Integrated Care Management is responsible for providing clinical and operational oversight of a multidisciplinary care team. The supervisor ensures effective coordination with other supervisory staff to support seamless transitions between levels of care for members and contributes to the development of a cohesive and high-performing unit and is accountable for meeting established productivity and quality standards with accuracy to achieve the Health Services department's overall performance metrics.

Qualifications

• Bachelor’s degree in nursing, psychology, or social work (master’s preferred), with three (3) years of care management experience and at least one (1) year of supervisory experience in a health care or managed care setting preferred.
• Education and Experience
• Advanced organizational and time management skills, combined with ability to provide supervision, guidance, and support to a multidisciplinary team.
• Intermediate Microsoft Office Suite application skills, (e.g., Outlook, Word, Excel, Teams, Visio, and PowerPoint).
• Intermediate skills in developing and maintaining effective interpersonal relationships with providers, members, community partners, public agencies, and government programs.
• Knowledge
• Extensive knowledge of health care and/or community case management models.
• Working knowledge of Medicare and Medi-Cal regulations and requirements related to care coordination, case management, transitions of care, and documentation standards.
• Working knowledge of compliance standards in CMS, NCQA, DHCS, CalAIM, HIPAA and organizational care management.
• Abilities
• Demonstrated ability to lead and collaborate effectively with diverse teams and partners to achieve outcomes.
• Demonstrated ability to interpret clinical information and support staff in applying evidence based care management approaches.
• Demonstrated ability to use care management platforms and electronic documentation systems to guide staff and monitor performance.
• Demonstrated ability to support change management and operational implementation of new programs, policies, or regulatory requirements.

Duties & Responsibilities

• Leading People
• Develop, manage, and lead a team of self-accountable professionals by modeling real, personal accountability and instilling a culture of psychological safety and accountability.
• Support direct reports in holding themselves accountable to high performance standards and professional conduct in a clear, helpful, straightforward way.
• Conduct one-on-one conversations with direct report(s), focused on performance, development, and career growth.
• Ensure compliance with labor laws/regulations, support the implementation of organizational policies and procedures, and foster a positive and inclusive culture.
• Support the development, implementation, and monitoring of the department budget, to ensure efficient resource allocation and compliance with policies.
• Delivering Results
• Supervise and coordinate care management services; establish efficient workflows and address barriers to implementation.
• Create and revise workflows, job aids, and training materials to support staff and operations.
• Ensure staff consistently meet operational, clinical, and compliance standards.
• Leading Change
• Maintain and provide backup coverage to ensure achievement of all internal and external needs, including creating, delegating, and managing special projects, audits, and reports.
• Provide caseload coverage as necessary in the absence of clinical and non-clinical staff.
• Drive team goals focused on health outcomes and high-quality member experience.
• Support Manager in developing and operating quality assurance programs for clinical and non clinical staff to strengthen best practices and service quality.
• Building Coalitions
• Lead hiring, onboarding, training, and evaluation of new staff.
• Partner with Manager to identify training needs and develop educational programs, training materials, competency tools, and orientation checklists that promote staff development and continuous quality improvement within ICM.
• Collaborate with Manager to ensure continuous quality improvement and monitor compliance with DHCS, CMS, NCQA and other governing organizations as required.
• Facilitate interdisciplinary team meetings (IDTs), case conferences, and team huddles.