Supervisor, Case Management Health Integrated
THIS JOB HAS EXPIRED Description
JOB SUMMARY: The Supervisor of Case Management is a full-time position that provides day-to-day professional, technical, and managerial support to the Case Management team to ensure compliance with program policies and procedures, industry standards, and regulatory requirements. This individual will be responsible for the integration and coordination of Case Management services, working closely with HI technical support staff, managerial staff, and other clinical departments. The Supervisor of Case Management will assist in the daily functioning and productivity of the clinical staff. This individual will serve as a liaison among HI Case Management staff, members, and health care practitioners/providers. The Supervisor of Case Management will assess opportunities for efficiency, provide formal and informal evaluative feedback to staff, and coordinate schedules of permanent, part-time and temporary staff, direct team leaders, and plan meetings to increase awareness of company/department policies and procedures and to satisfy the above listed directives.
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 healthcare professional (RN, CCM) with current, unrestricted license required.
If the Supervisor 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 required. Master?s degree in social sciences preferred.
Minimum 2 years case management and/or behavioral health management experience required.
Two- three years clinical experience in case management or acute hospital discharge planning required.
Three years full-time direct clinical or critical care to patients in a medical/surgical or behavioral health setting.
Knowledge of Case Management planning, design and implementation.
Able to develop operational tools or enlist resources when opportunities for improvement are identified.
Able to evaluate program progress and/or identify problems or concerns and develop successful resolutions.
Able to develop relationships with a wide range of individuals and organizations.
Able to follow organizational policies and procedures, government laws, regulations, and guidelines.
Excellent interpersonal, verbal and written communication skills.
Ability to work with internal customers to facilitate program development.
Excellent computer skills.
Strong understanding of managed care organizations, health benefit structures, and community resources.
Able to work independently and make decisions.
Call center knowledge preferred.
Provides feedback on the design, maintenance, and performance of the Case Management.
Provides the day-to-day professional and technical support to the Case Management compliance with policies and procedures, contractual obligations and regulatory requirements.
Functions as a coordinator for staff coverage and departmental activities, ensuring appropriate staffing and addressing any QI concerns as necessary.
Communicates Case Management Program policy changes, development and company updates to the respective staff, supporting the business decisions while implementing the necessary adjustments by staff members.
Maintains and promotes expertise in traversing the Case Management product, including client specifics, by ensuring staff conduct the Case Management activities in accordance with client demands and HI contractual obligations.
Articulates a thorough understanding of all HI policies and procedures as related to the delivery of the Case Management and ensures the same to the staff as appropriate to their individual responsibilities.
Provides regular feedback regarding staff training and/or other training/educational needs.
Performs review/audits on staff performance and Case Management activities to ensure compliance with departmental policies and procedures, quality improvement activities, HR standards, and clients? needs.
Identifies, investigates, evaluates resolves and conducts follow-up on all policies and procedures issues/concerns, and communicates and issues/concerns with Manager of Behavioral Health.
Works with all HI staff and departments in a cooperative, goal-directed manner to achieve company and departmental goals.
Participates in providing input in Case Management policies and procedures.
Coordinates and participates in Case Management monitoring and reporting.
Ensures delivery of required reports as outlined in the Case Management as required contractual obligations and/or by regulatory agencies.
Provides input on Case Management system issues and enhancements.
Assists clinical/professional staff as needed with problem solving related to difficult situations, and patient specific issues.
Provides for supervision of non-clinical staff
Work to ensure all programs effectiveness, quality, productivity, profitability and patient safety.
Provides orientation to new staff and assists with education and training as needed.
Provides supervision and oversight to clinical and non-clinical staff.
Ensures that Case Management staff consults with and seek advice form licensed physicians with expertise appropriate to the types of services being managed.
Analyze all programs to ensure effectiveness, quality, productivity, profitability and patient safety.
Promotes working relationships that support the growth and success of staff members.
Identifies potential intradepartmental personnel problems and issues proactively and readily utilizes HI Human Resources policies and procedures to facilitate resolutions.
Communicate to the Ar. Managers of other areas, all problems, concerns and/or makes recommendations when opportunities for improvement in staffing management are indentified.
Conducts staff performance reviews in a consistent, accurate and timely manner consistent with HI policies and procedures.
Maintains a team approach in writing, delivering and evaluating performance and implementing corrective actions by utilizing the expertise of the HR manager.
Identifies potential for reorganizing or redirecting staff activities to promote efficient delivery of Case Management services.
Identifies and promotes educational/training opportunities for the Case Management staff, serving as a resource professional.
Promotes a positive working environment.
Identifies, communicates and resolves potential interdepartmental personnel/peer problems and issues proactively, readily utilizing the HR Manager, and when appropriate managerial staff, as resources.
Actively participates in team meetings and departmental meetings.
Emphasizes preventative problem solving skills, utilizing evidence-based practice guidelines and staff empowerment strategies,
Evaluates clinical and economic outcomes on an ongoing basis with the goal of improving integration of services to ensure overall program performance.
Ensures that licensed health professionals are readily available to answer questions and non-clinical staff is performing within the scope of the on-clinical role.
Works, communicates and collaborates in a courteous, professional manner with patients, client/health plans, and all members of the multidisciplinary health care team on all Case Management initiatives.
Effectively resolves Case Management issues and communicates appropriately and according to HI policies and procedures, and/or regulatory requirements with the practitioner(s), provider(s), and patient/patient?s legally appointed representative.
Effectively identifies opportunities for intervention.
Supports the physician or practitioner/patient relationship.
Promotes patient self-management education, including primary prevention, behavior modification programs, and compliance monitoring.
||10008 North Dale Mabry |
Tampa, FL 33618
THIS JOB HAS EXPIRED