Case Management Manager

The Opportunity

The Case Management Manager manages the case management team and the care coordination of behavioral health members to develop and assess high-quality, cost-effective healthcare outcomes related to mental and behavioral health needs. Manages escalations and care management issues related to members or providers. Job functions are performed in accordance with the requirements of the QUEST Integration contract and health plan goals and quality outcome metrics.

• Oversee and review case management required documentation to maintain compliance with federal and state regulations and contractual agreements.
• Develop, implement, and oversee case management policies and procedures within the case management team based on regulatory requirements and industry standards.
• Direct the daily activities of case management staff including reviewing and approving the caseloads of case management staff based on state requirements, case management staff experience, and member needs.
• Manage escalated and complex care cases and provide guidance to team members to address member concerns related to mental and behavioral health members.
• Manage resolutions of complaints and assist in audits and evaluations related to care programs.
• Develop, implement, and oversee case management programs to facilitate the use of appropriate services and resources.
• Set goals and objectives for case management team to achieve cost-effective healthcare results.
• Work with case management senior management to provide updates and insights on case management team goals.
• Provide feedback to case management team to improve members and provider experience and high-quality care.
• Educate and provide resources for case management team on key initiatives and member outreach to facilitate on-going communication between care management team, members, and providers.
• Assists case management senior leadership with onboarding, hiring, and training new case management employees, recent promotions, and transfers within the department.
• Strategically plan and optimize team resources, ensuring that they are aligned to business needs, initiatives, and performance gaps.
• Provides oversight of field-based case management operations to ensure compliance with all required case management activities, established time frames, and mandatory reports.
• Ensures alignment and achievement of departmental goals and organizational priorities, including quality, compliance, member outcomes, and cost-of-care targets.
• Accountable for accurate and timely completion of all required reports and assessments, in collaboration with internal departments within Aloha Care.
• Conduct regular performance monitoring and reporting through audits.
• Develop, maintain, and continuously improve reporting and dashboards to track progress, monitor team and individual performance, identify trends, and inform leadership decision-making and corrective actions.
• Ensure accurate and timely completion and submission of required regulatory reports by collecting and validating data, collaborating with internal stakeholders, and maintaining documentation to demonstrate compliance with requirements.
• Implement the strategic goals of Aloha Care’s CCS Integration program, translating them into specific, measurable, operating and business plans.
• Lead efforts and participate in internal and external audits by preparing documentation, ensuring data accuracy and timeliness; respond to audit inquiries and implement corrective actions to address findings and maintain ongoing compliance.
• Work with Quality Improvement and Medical Directors/Psychiatrists to develop and implement metrics that identify and mitigate barriers to improve member’s health care outcomes and goals for independence.
• Create and conduct provider outreach initiatives, and/or training in conjunction with Aloha Care’s Provider Relations Department.
• Develop and maintain strong relationships within the community including State and Federal leaders, providers, vendors, business partners and community alliances.
• Participate in Case Management staff meetings, interdisciplinary care team meetings and staff manager meetings as…