Care Management Supervisor, SCO at BMC HealthNet Plan in Boston, Massachusetts

Posted in Other 16 days ago.





Job Description:



Care Management Supervisor, SCO

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The Supervisor of Care Management, Senior Care Options is responsible for the daily supervision and operations of the SCO Care Management team. This will include day-to-day mentoring and oversight of Registered Nurse Care Managers, Social Work Care Managers, Care Management Coordinators, Care Navigators, Community Health Workers, and new hires. Assigns work, ensures compliance with policies and procedures and is the first point of contact for complex issues to ensure cost-effective, quality, and safety, as the senior population accesses services throughout the continuum of care to include those living in the home environment with community integration, other residential care communities and/or skilled nursing facilities.



The Supervisor works in close partnership with the CM Trainer, Clinical Vendor Managers, LTSS Coordinator, ASAP Vendor Manager, and UM Specialists and will become strongly knowledgeable of all departments throughout BMCHP and their responsibilities to the SCO population, carrying out internal integration points as built by the Manager and Trainer of CM across the Office of Clinical Affairs (OCA). The Supervisor will become proficient in the full SCO contractual requirements, BMCHP systems and vendor and agency contracts of whom BMCHP outsources for the SCO population. As requested by the Manager of CM, the Supervisor will attend and participate in meetings with internal and external stakeholders and ensure the staff carries out processes as they are built that will be necessary for a successful SCO program. Under the direction of the Manager, the Supervisor may participate in external SCO program reviews such as readiness, External Quality Review Organization (EQRO) reviews, other.



Key Functions/Responsibilities:



  • Monitors and evaluates the quality, timeliness and accuracy of MDS and HRA assessments, Individual Care Planning and Integrated Care Team review and approval.

  • Collaborates with the utilization management team, LTSS coordinator, ASAP vendor manager and CM trainer.

  • Participates in staff hiring, work allocation, training, performance management in collaboration with the Manager of CM, professional development and related supervisory functions.

  • Develops strong relationships with providers, community and social service organizations to ensure that Enrollees have access to the range of supportive services in accordance with the ICP.

  • Consults with the Manager of CM, Trainer, and staff to identify/implement workflow and process improvements to maximize quality, efficiency and cost effectiveness of the team.

  • Assists with and participates in the planning, development and implementation of SCO CM department specific and cross functional projects.

  • Responsible for tracking interventions to address opportunities for improvement in overall CM performance.

  • Accountable for timely notification to the Manager if staff performance falls below expectations, and works with leadership to develop an improvement plan to improve.

  • Identifies members who could benefit from multidisciplinary rounds.

  • Enters data accurately, timely, and completely; documents all encounters according to the department policies and workflows and complies with contractual requirements regarding turn-around-times.

  • Conducts routine audits to monitor compliance with workflows, job aids, and activities.

  • May maintain caseload volume and turnaround times meeting department productivity standards, business need requires.

  • Provides high level of service and satisfaction to internal and external customers.

  • Supports CM initiatives through communication strategies, team leadership, facilitation and recommendations.

  • Under the direction of and in collaboration with the Manager of CM, develops and uses metrics and management reports to monitor staff productivity and efficiency.

  • Monitors case inventory and team members' workload and adjusts as necessary.

  • Responds to staff issues and concerns and escalates to management as appropriate.

  • In conjunction with CM Trainer and Manager, assists with onboarding new hires and on-going role specific training, including development of training materials as it relates to SCO CM.

  • Other functions as required to support departmental activities.



Qualifications:


Education:



  • Registered Nurse

  • Bachelor's degree or an equivalent combination of education, training and experience is required


Experience:



  • 2 years of prior supervisory experience

  • 3 years-experience with case management, care coordination, long term services and supports and/or discharge planning, MDS assessments, preferably with a Senior Care Options Plan/for the elderly population

  • Experience in working with and supervising interdisciplinary teams including RNS, SWs, and support staff


Experience Preferred/Desired:



  • Experience in acute care and/or rehab care/case management

  • Experience with Medicaid/Medicare recipients and community services

  • Experience with healthcare care management database

  • Experience managing a remote workforce

  • Experience with the Medicaid, Medicare, and/or Senior population

  • Experience with ASAPs


Required Licensure, Certification or Conditions of Employment:



  • Certification in case management (CCM) preferred

  • Valid applicable current state licensure as a Registered Nurse


Competencies, Skills, and Attributes:



  • Excellent clinical and assessment skills

  • Strong supervisory and mentoring skills

  • Ability to lead a team

  • Ability to work collaboratively and build strong relationships with providers, Enrollees, and the PCT, and within all levels of the organization

  • Detail oriented

  • Excellent proof reading and editing skills

  • Excellent Windows and Microsoft Office skills

  • Demonstrates excellent organizational skills

  • Flexible, independent, self-starter with an ability to thrive in a fast paced environment

  • Demonstrates commitment to quality

  • Projects positive, team oriented demeanor

  • Strong interpersonal skills including effective listening and ability to support, motivate and guide others

  • Process improvement skills

  • Strong oral and written communication skills

  • Ability to successfully plan, organize and manage projects


Working Conditions and Physical Effort:



  • Available after regular workday to staff that are on call or may need to occasionally be on call

  • Work may include working in the field, member homes

  • Travel within the SCO geographic network required



*Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status.