Senior Manager of Care Management

Overview

The Senior Manager of Care Management reports directly to the Director of Care Management and is responsible for the auditing, monitoring, assessment, and oversight of processes within the Care Management department for the Medicare lines of business. This position requires a hands-on, data-driven people leader who will have broad accountability for developing, assessing and analyzing comprehensive auditing tools required to ensure standardization and consistency of departmental activities, and departmental compliance to regulatory standards.

This role communicates regularly with regulatory entities reporting internal and external compliance and metrics to clinical programs. Reporting to this role are licensed and non-licensed staff.

• Analyze Medical Management documentation and data, and evaluate department processes to identify opportunities for improvement, including supporting regulatory compliance.
• Collaborate with senior leaders on new and existing clinical programs in alignment with Model of Care.
• Provide direction and guidance to the clinical team on contractual requirements and standards, while serving as the subject matter expert and lead on contractual deliverables.
• Engage in ongoing performance management of direct staff including coaching, mentoring, development, training, and succession planning to include hiring and termination decisions. Lead ongoing training needs assessment process.
• Develop processes and tools to monitor and ensure quality and consistency in staff performance across all areas of medical management.
• Work with Managers to determine root cause for performance deficiencies, and develop improvement strategies for any inconsistencies or gaps identified.
• Drive quality and productivity initiatives based on departmental and organization needs.
• Responsible for program development, outcomes measurement, KPIs reporting, and contractual oversight.
• Assist in the development and operationalization of new programs that meet regulatory and contractual requirements.
• Ensure clinical standards/requirements are met across all medical management teams and partner agencies that deliver Care Management services.
• Oversight of the development of tools and processes that ensure clinical program activities comply with the requirements established by contractual and regulatory entities.
• Assist in identifying opportunities and cost/benefit for programs, and enhancements to existing programs, using data analysis tools.
• Provide leadership in being the expert on state and federal program requirements, and proposing solutions to department oversight that increase efficiency and improve outcomes.
• Work closely with Compliance, Quality, and other stakeholders to help clarify questions and issues related to the operationalization of state and federal requirements, as well as accreditation standards.
• Lead a team of licensed and non-licensed staff who support clinical program outcomes.
• Provide regular reports and presentations on department quality improvement initiatives, progress toward goals, and performance against standards.
• Work with the leadership team to set expectations and targets for quality, productivity, caseloads, and outcomes.
• Oversee delegated/accountable entity performance and collaborates with contract managers to align expectations.
• Work closely with directors and vice president to ensure initiatives, measurement and content are aligned with expectations.
• Attend meetings and produce reports for contractual and regulatory bodies as required.
• Develop, maintain, and ensure execution of quality improvement initiatives.
• Other duties as assigned.
• Corporate Compliance Responsibility — As an essential function, responsible for complying with Neighborhood’s Corporate Compliance Program, Standards of Business Conduct, applicable contracts, laws, rules and regulations, policies, and procedures as it applies to individual job duties, the department, and the Company. This position must exercise due diligence to prevent, detect and report unlawful and/or unethical conduct by fellow co-workers, professional affiliates, and/or agents.

• Bachelors Degree in Health-Related Field
• Acti…