Manages the activities of supervisory associates and their subordinate work group(s) and/or exempt individual contributors for assigned area of responsibility. Works with the Supervisor(s) and Case Managers to assess, plan, implement, coordinate, monitor, and evaluate services and outcomes to maximize the health of the Member.
DEPARTMENT: Mer-IL-Case Mgmt.
REPORTS TO: Sr. Manager, Non-Clinical Care Mgmt.
Manages and develops direct reports who include supervisory and/or exempt professional personnel including but not limited to hiring, mid-year and annual reviews, Performance Improvement Plans (PIP), terminations, etc.
Develops and implements case management workflows and policies & procedures.
Partners & collaborates with other departments cross functionally regarding case management and/or Clinical Services initiatives.
Manages & resolves e-mails and escalated phone issues in response to provider, staff and other department requests.
Directs work assignments, measures results and initiates personnel actions as required.
Develops, implements and manages process improvement initiatives.
Establishes objectives, schedules, and manages cost data for Case Management Department.
Coordinates activities of unit to meet contractual company deadlines and resolves interpersonal conflicts.
Applies a comprehensive knowledge of Case Management to the completion of assignments.
Proactively monitors appropriate metrics to drive up efficiency.
Chairs case management committees as applicable.
Maintains current knowledge of case management topics and acts as the unit’s subject matter expert (SME) on case management at department and company meetings.
Performs special projects as needed.
Required a Bachelor's Degree in Health Administration or equivalent work experience at an MCO
Required 5+ years of experience in an acute clinical care setting and/or MCO related experience
Required 3+ years of experience in case management
Required 1+ year of management experience
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 ability to drive multiple projects
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 knowledge of healthcare delivery
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
Intermediate ability to implement process improvements
Intermediate ability to analyze and interpret financial data in order to coordinate the preparation of financial records
Required intermediate Microsoft Outlook
Required intermediate Microsoft Word
Required intermediate Microsoft Excel
Required intermediate Healthcare Management Systems (Generic)