Senior Care Manager - Peak Health

About the role

Reporting to Manager of Care Management, the Senior Care Manager will be an integral member of the health plan’s medical management team. This position is responsible for onboarding new employees and mentoring members of the care management team including providing education, performing documentation audits, and building clinical team members expertise through direct feedback and real-time coaching.

Responsibilities

• Participate in activities related to care management program build, implementation, oversight, and delegation.
• Utilizing NCQA documentation standards, performs audits of member records as part of care management oversight processes.
• Affords support and coaching to Care Managers and other clinical team members.
• Takes escalated calls or fills-in for the Care Manager team during high-peak periods.
• Assists in quarterly reporting of delegated case management processes to meet accreditation standards.
• Affords clinical, procedural or interpretational assistance.

Requirements

• Current Registered Nurse license issued by the state in which services will be provided or current multi-state Registered Nurse license through the enhanced Nurse Licensure Compact (eNLC).
• Five (5) years of healthcare clinical experience.
• Five (5) years Care Management experience.

Qualifications

• Bachelor's Degree in Nursing OR Associate of Science in Nursing Degree (ASN); Currently enrolled in a BSN program and BSN completion within three (3) years of hire.

Skills

• Demonstrated knowledge of CMS regulatory and contractual documents; knowledge of Medicare Advantage, NCQA accreditation standards, disease management, utilization management, care management and discharge planning.
• Excellent written and oral communication.
• Problem solving capabilities to drive improved efficiencies and customer satisfaction.
• Attention to detail.
• Proficiency with Microsoft Office products.
• Ability to work under stressful working conditions.
• Meeting defined deadlines and deliverables is an imperative skill for this role.

Pay

Scheduled Weekly Hours: 40
Exempt/Non-Exempt: Shift: United States of America (Exempt)

Schedule

United States of America (Exempt)

Benefits

Not specified