Team Lead, Community Based Care Management - R13188-1

Job Summary

The Team Lead, Community Based Care Management provides front line management and support to departmental leadership in the development and execution of the Care Model in alignment with corporate goals.

Essential Functions

• Functions as a “hands-on” supervisor, assisting in day-to-day operations and supervision of staff with adherence to departmental expectations
• Responsible for recruiting, hiring, onboarding, training and ongoing support of the departmental team
• Counsels and supports staff in the effective administration of CM program
• Prepares and utilizes reports to monitor and audit all systems, procedures and the quality of customer services provided
• Assists with representing the unit at Departmental and Planning meetings as requested
• Ensures staffing policies, procedures and SOPs are standardized and are current to meet business needs
• Aids in the review and development of new projects/processes as requested by the health plans
• Oversees appropriate system documentation within defined protocols and guidelines
• Serves as interdepartmental liaison, collaborating with internal resources in monitoring service levels to meet requirements and analyzing for trends
• Participates in meetings with internal/external resources to provide information about services and benefits available to members and referral mechanisms
• Arranges and coordinates services with community partners to maximize utilization of appropriate community resources and support groups
• Participates in the development of budget and performs ongoing monitoring of status
• Aids in the implementation of interventions to maintain and/or improve the quality and efficiency of the operations/services provided
• Performs any other job duties as requested

Education And Experience

• Completion of an accredited registered nursing (RN) degree program, Bachelor’s Degree in Social Work, or Master's degree as relevant to licensure eligibility is required
• A minimum of three (3) years of healthcare experience is required
• A minimum of two (2) years of managed care and/or case management experience is preferred
• Previous supervisory experience is preferred

Competencies, Knowledge And Skills

• Ability to display a customer service, member-focused orientation
• Strong data analysis and trending skills
• Strong team and staff development skills
• Strong collaboration and conflict resolution skill sets
• Strong decision making and problem solving skills
• Exceptional communication skills (both written and verbal)
• Ability to develop, prioritize and accomplish goals/time management
• Effective listening and critical thinking skills
• Strong ability to teach best practice, engagement strategies for successful member participation (including motivational interviewing, best practice engagement techniques)
• Knowledge of state and federal healthcare regulations and environment
• Ability to work in a fast-paced environment
• Ability to work independently and within a team environment
• Advanced knowledge of Microsoft Word, Excel, PowerPoint and Visio
• Ability to operate smart phone, iPad or other mobile communication devices

Licenses And Certifications

• Active, unrestricted Registered Nurse (RN) license, Social Work license, or Counselor license is required
• Case Management certification is preferred

Employment Requirements

• Valid driver’s license, vehicle and verifiable insurance
• Passing driver’s license record check and verified insurance
• Annual proof of Influenza vaccination for designated positions during Influenza season (October 1 – March 31) as a condition of continued employment

Working Conditions

• This is a mobile position, meaning that regular travel to different work locations, including homes, offices or other public settings, is essential
• May be exposed to weather conditions typical of the location
• 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
• Required to use general office equipment, such as a telephone, photocopier, fax machine, and personal computer

Compensation Range

$72,200.00 - $115,500.00

Competencies

• Fostering a Collaborative Workplace Culture - Cultivate Partnerships - Develop Self and Others - Drive Execution - Influence Others - Pursue Personal Excellence - Understand the Business

Working Conditions

• This is a mobile position, meaning that regular travel to different work locations, including homes, offices or other public settings, is essential
• May be exposed to weather conditions typical of the location
• 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
• Required to use general office equipment, such as a telephone, photocopier, fax machine, and personal computer