Manager, Care Management Health Integrated
THIS JOB HAS EXPIRED Description
JOB SUMMARY: The Manager of Care Management is a full time position, responsible for assisting the
Director of Medical Care Management in the day to day management of operational, clinical and functional
support for the following programs: Medical Utilization Management, Case Management and day to day
oversight of Health Contact Partners (HCP) Nurse Triage contract. The Manager (1) supervises staff including
hiring, coaching and completion of performance evaluations. (2) Assists with policy and procedures,
accreditation and regulatory standards. (3) Offers input and works with the appropriate departments to support
the development and launch of new programs; (4) works with clients to deliver quality products and provide
excellent customer service.
SCOPE OF PRACTICE: Case Management, according to the Case Management Society of America, is defined as; ?a collaborative process of assessment, planning, facilitation for options and services to meet an individual's health needs through communicating available resources to promote quality cost-effective outcomes.? This service is recognized as an organized process designed to ensure the medical necessity and cost effectiveness of a proposed service. Case Management is designated to promote optimal recovery and rehabilitation by professional involvement in the rehabilitation process.
Licensed RN with current, unrestricted license required.
If the Manager has directly supervised the case management process for at least 3 years with Health Integrated, they will hold a certification in case management from the URAC approved list of certifications.
Case Management certification within three years of employment required.
Bachelor?s degree preferred in a health science.
Two-three years clinical experience in case management or acute hospital discharges planning required.
Three years full-time direct clinical or critical care to patients in a medical/surgical or behavioral health setting.
5 years experience in Triage or Utilization Management or Case Management, and/or other managed care or cost management program with at least 3 of the 5 years in direct supervision of Case Management required.
At least 5 years Call Center Management experience preferred.
Experience with application of healthcare criteria systems and programs, e.g. Triage, InterQual, Milliman.
Must have previous experience with URAC and or NCQA accreditation process.
Ability to manage and coordinate programs, projects, resources, and staff across multiple company functions;
Strong administrative qualities to analyze goals, products, programs, and processes and make recommendations for changes;
Knowledge of all aspects of the following managed care products: utilization management, case management, disease management and triage;
Organizational and project management skills;
Experience working with clinical documentation programs designed for case management, disease management, utilization management and triage programs;
Strong computer skills and experience with Microsoft Office;
Strong communication, interpersonal and leadership skills.
Coordinates and manages all Medical Utilization Management, Case Management, and Nurse Triage programs.
Assure job descriptions and staff roles/responsibilities are accurate and current;
Responsible for supervision and oversight of staff
Supervise the interviewing and hiring of staff and supervisors for the above programs;
Assist in the licensing and accreditation process for all programs;
Assure that all regulatory and accreditation standards are implemented and met;
Assure that Policies & Procedures, Operational Guidelines, and process workflows are current meet quality accreditation and regulatory standards, and are communicated to and available for staff on the IntraNet;
Develop annual Workplan & Evaluation for each program in conjunction with the QI committee (includes goals, objectives, and planned new processes/enhancements) and communicates the Annual Workplan and previous year?s Summary to Senior Management and staff;
Assist the Quality department in the development and evaluation of an annual QI plan for all programs and assures all indicators are met;
Participate in the Quality Committee and assists in related functions;
Analyze all programs to ensure effectiveness, quality, productivity, profitability and patient safety;
Coordinate all programs and work with other Health Integrated Departments and Committees, i.e. Quality Committee, Education, Account Management, etc;
Assist in new product development efforts and assures current products are being delivered as designed;
Assist the Director in plans for growth;
Provide input and direction to Information Services on systems issues and enhancements;
Offer input and assist with development of orientation, education and training programs
Assure delivery expectations of client contracts are being met;
Assist in the development of management reporting capabilities and works with supervisors to ensure they understand and use them to effectively manage the delivery of services; and provide required reports and special projects as needed.
Ensure clinical staff consult and seek advice from a licensed physician with expertise appropriate to the types of services being managed
Customer Service ? Internal:
Work with supervisors and staff to develop a high level of morale, positivity, and commitment in the work environment;
Provide strong leadership role model for supervisors and staff;
Identify problems, issues and/or concerns proactively or as they arise and resolves them as quickly as possible;
Develop strong working relationships with all internal staff members to encourage a cooperative sharing of ideas and support;
Monitor and report any quality of care issues or concerns to Quality Management;
Maintain a courteous and professional attitude when working with all staff members and the management team;
Ensures that licensed health professionals are readily available to answer non-clinical staff questions and shall ensure that non-clinical staff are performing within the scope of the non-clinical role;
Customer Service ? External:
Lead /Support Corporate initiatives as directed
Work, communicate and collaborate in harmony and in a courteous and professional manner with members, practitioners, providers, multidisciplinary health care team members, and clients;
Work collaboratively with the health plan?s management team to assure quality service delivery that meets client expectations; and
Serve as a liaison and patient advocate, when applicable, for quality of care and cost outcomes.
Lead /Support Corporate initiatives as directed
Direct and /or Assist in the investigation and implementation of operational systems
Drive development of policies, procedures and processes that support operations excellence
Set overall strategy and direction for direct reporting business units
Make hiring and separation decisions as required
Lead, mentor, coach and assess the performance of all direct reports
Relationship build with HI Clients which may involve travel as well as frequent meetings
||10008 North Dale Mabry |
Tampa, FL 33618
THIS JOB HAS EXPIRED