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Supv, Pediatric Care Management at WellCare

Posted in Health Care 30+ days ago.

This job brought to you by eQuest

Type: Full-Time
Location: Miami Gardens, Florida

Job Description:

Supervises staff, ensures appropriate workload distribution and oversees day to day workflow processes. Ensures team is compliant with all Model of Care regulatory requirements and produces optimal clinical and resource outcomes. Works with case managers to assess, plan, implement, coordinate, monitor and evaluate services and outcomes to maximize the health of the member.

Reports to: Director, Field Care Management

Department: Case Management

Location: Dade

Essential Functions:

  • Assists management in collaborating with Health Services, Operations and Information Technology departments to ensure full integration of case management reporting throughout the organization.

  • Assists Case Mangers in completing comprehensive assessment and care plans to evaluate the member’s need for services.

  • Monitors associate performance and conducts counseling/corrective action procedures when required. Identifies concerns, brings issues to management’s attention and offers suggestions for improvement.

  • Provides significant input to performance evaluation, hiring and termination decisions for associates in work group.

  • Reviews time records, sets schedules and approves all vacation/time off requests for subordinate associates.

  • Provides training and guidance to new and current Case Managers regarding policy & procedure, systemic tools, workload and care plan development.

  • Answers all questions and assists peers and management with delegated tasks or projects.

  • Takes the lead in preparing and submitting projects, reports or assignments as needed to meet department initiatives and/or objectives.

  • Ensures phone or team coverage due to fluctuations in staffing levels.

  • Ensures regulatory requirements and accreditation standards are applied to all activity and reporting.

  • Plays active role in creating, applying and utilizing accepted policies and procedures.

  • Attends company meetings in absence of manager or director.

  • Performs other duties as assigned
Additional Responsibilities:

    Candidate Education:

    • Required An Associate's Degree in nursing or Graduation from Diploma Nursing School or health related or behavioral science field

    • Preferred A Bachelor's Degree in nursing

    • Required Other For Illinois' Children with Special Needs program, a Master's degree in Nursing, Social Sciences, social work, or a related field plus 3+ years of experience in a human services field is required.

    • Required Other For Florida Managed Long Term Care program, a Master’s degree in human service, social science or health field plus a minimum of 2 years’ experience in case management is required. OR Bachelor’s degree in human service, social science or health field plus a minimum of 5 years’ experience in case management is required
    Candidate Experience:

    • Required 4+ years of experience in an acute clinical care setting and/or MCO related experience

    • Required 2+ years of experience in current case management

    • Required Other For Florida Managed Long Term Care program, 1+ years elderly and disabled population case management experience.
    Candidate Skills:

    • Intermediate Ability to drive multiple projects

    • Intermediate Ability to work independently

    • Intermediate Demonstrated time management and priority setting skills

    • Intermediate Ability to work in a fast paced environment with changing priorities

    • Intermediate Demonstrated written communication skills

    • Intermediate Demonstrated interpersonal/verbal communication skills

    • Intermediate Ability to create, review and interpret treatment plans

    • Intermediate Demonstrated negotiation skills

    • Intermediate Ability to lead/manage others

    • Advanced Ability to analyze and interpret financial data in order to coordinate the preparation of financial records

    • Advanced Ability to effectively present information and respond to questions from families, members, and providers

    • Advanced Ability to effectively present information and respond to questions from peers and management

    • Advanced Knowledge of healthcare delivery

    • Intermediate Ability to implement process improvements
    Licenses and Certifications:
    A license in one of the following is required:

    • Required Licensed Registered Nurse (RN)

    • Preferred Certified Case Manager (CCM)

    • Preferred Other Incumbents supporting New Jersey’s LTSS program are not required to have an RN license
    Technical Skills:

    • Required Intermediate Microsoft Word

    • Required Intermediate Microsoft Excel

    • Required Intermediate Healthcare Management Systems (Generic)

    • Required Intermediate Microsoft Outlook

    • Preferred Other Bilingual skills