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 ongoing training, mentoring, coaching and disciplinary action as needed
• Participate in the hiring process of new Integrated Care Management personnel
• Provide guidance/instruction for Integrated Care Team Leads and other staff via formal and informal meetings
• Regular travel to conduct member visits, provider visits and community based visits as needed to ensure effective administration of the program
• Perform any other job duties as requested

• Bachelor’s Degree in Nursing, healthcare field, business administration or related field or equivalent years of relevant work experience required
• Minimum of five (5) years or more of clinical experience is required
• Minimum of three (3) years Medicaid and/or Medicare managed care or HCSB Waiver case management experience is preferred
• Three (3) years as a case manager is preferred
• Two (2) years of management experience is preferred

• Intermediate proficiency level of Microsoft Outlook, Word and Excel
• Ability to operate smart phone, iPad, or other mobile communication devices to ensure productivity and ability to perform essential functions
• Ability to communicate effectively with a very diverse group of individuals
• Ability to multi-task and work…