Manager, Case Management RN- Integrated Care

Job Summary

The Manager, Case Management
- Integrated Care is responsible for overseeing the Integrated Care Duals Product Teams in coordinating the care, service and health benefits for selected member populations.

The Manager, Case Management
- Integrated Care is responsible for overseeing the Integrated Care Duals Product Teams in coordinating the care, service and health benefits for selected member populations.

• Monitors and promotes safe and effective utilization of healthcare resources through clinical variance and benefits management
• Actively manages the performance of the Integrated Care Management Liaisons and internal/external Care Management teams to ensure safe and effective service delivery, quality outcomes, and compliance with all state and accreditation requirements
• Assist in verifying eligibility, previous enrollment history, demographics and current health status of each member as appropriate
• Audit and review documentation gathered by internal staff and external partners to ensure thoroughness, accuracy and care management competency
• Contribute to the ongoing review of Member care plans, defining specific issues, goals and interventions as appropriate
• Responsible for ensuring that member/CM caseload ratios are kept at optimal levels
• Ensures that CM teams monitor and evaluate care plan effectiveness on an ongoing basis through member, family, provider, and stakeholder contact
• May assist Member liaisons in the facilitation and coordination of services based upon the care treatment plan developed in collaboration with all stakeholders
• Working with peer Managers and Director, responsible for overall day-to-day Care Center operations, team coordination, and member outcomes, including, new staff orientation and scheduling, training, in-servicing, quality and performance improvement, regulatory and contractual compliance
• Oversees effective care planning and implementation meeting member needs
• Oversees the coordination of services with community partners to maximize utilization of appropriate community resources and supports, and assure effective and appropriate transitions between settings of care
• Works with Incident Management staff in the review and investigation of member incidents and/or issues related to member health and safety
• Works with Community Partners, Provider Relations and Network Management staff in the ongoing monitoring of quality issues for network providers
• Monitoring of scheduling/work allocation and productivity
• Provides quality monitoring and conducts regularly scheduled one-on-one meetings with all team members
• Works with corporate staff in the follow up and review of member complaints and grievances
• Monitor and analyze Integrated Care Management data and reporting
• Assures overall compliance with the Integrated Care product model of care
• Oversee and/or maintain current and accurate documentation of contacts, care treatment plans, case notes, referrals, and assessments in Care Management electronic record and within protocols and guidelines of the Care Management program
• Actively oversee the performance of the Integrated Care Management teams to ensure all state and accreditation requirements are achieved
• Review and update all Care Management policies and Standard Operating Procedures
• May participate in meetings with providers to inform them of Care Management services and benefits available to members
• Serve as interdepartmental liaison and network with other departments to gather/share information about issues related to the Care Management process
• May assist in education of member/caregiver regarding healthcare access and benefits, and provide member/caregiver with health education and wellness materials
• Precept and/or mentor new staff
• Provide…