POSITION TITLE: Manager, Case/Disease Management
JOB NUMBER: 700-011
DEPARTMENT: Utilization Management
GENERAL PURPOSE: The Case/Disease Management Manager provides direct supervision of Case and Disease Management staff to meet organizational goals. Supports all program activities related to state, federal and accreditation requirements.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
- Supervises assigned team, including but not limited to the following responsibilities: interviews, selects, and trains employees; provides on-going coaching, mentoring, and development of employees, fostering an atmosphere of teamwork; establishes performance goals with employees and monitors progress with regard to achievement of those goals; plans, schedules and directs the work of employees; evaluates employees’ performance and productivity; takes disciplinary actions with employees as needed; addresses employee complaints and grievances; makes decisions or effective recommendations with regard to the hiring, firing, promotion and other status changes, and pay rates of employees.
- Monitors Case/Disease Management activities and reports on trends to Health Services according to established standards.
- Coordinates Case/Disease Management staff’s workloads based on acuity levels.
- Facilitates early case findings by reviewing and assigning members from the daily census.
- Ensures Case/Disease Management decisions are based on established Plan/state/federal and accreditation standards and criteria.
- Implements and evaluates Case/Disease Management procedures within established guidelines.
- Directly supports related accreditation, State and Federal program requirements.
- Acts as a resource for staff on decision making and problem solving that supports program requirements.
- Participates in internal departmental and corporate activities/assignments as requested.
- Encourages staff growth and education.
- Develops policies, procedures and workflows as needed to assure ongoing compliance and opportunities for improvement.
- Monitors trends in the market or clinical guidelines updates to assess for program compliance/opportunities.
- Performs other duties as assigned.
QUALIFICATIONS AND REQUIREMENTS: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
EDUCATION and/or EXPERIENCE: Unrestricted Florida licensed RN; CCM or other related certification preferred; an undergraduate degree from an accredited institution of higher learning preferred; minimum five years related experience required; managed care experience or related management experience preferred; or an equivalent combination of education, training and experience.
NECESSARY KNOWLEDGE, SKILLS AND ABILITIES: Ability to: work from designated office for collaborative/interactive fulfillment of duties; appropriately and directly interact with other staff members and/or outside associates; manages member issues, performs telephone and/or computer work for extended periods of time; operate office equipment such as computer, telephone, and copy/scan/fax machine; attend and participate in meetings via phone, computer, or in person.
- Strong people management skills.
- Excellent organizational and prioritization skills,
- Excellent oral and written communication skills including good grammar, voice and diction with all educational levels or membership.
- Ability to participate in meeting Federal, State or Accreditation requirements/submissions under tight timeframes.
- Ability to manage data to perform analysis for suggestions of program changes.
- Familiarity with other ancillary functions such as HEDIS requirements and social services interventions.
- Comfortable in using multiple systems or databases.
- Intermediate proficiency in MS Office with emphasis on Word and Excel programs and intermediate level computer and keyboarding skills.
LICENSING AND CERTIFICATION: Unrestricted Florida licensed RN required; CCM or other related certification preferred.
PHYSICAL DEMANDS: The physical demands described are representative of those that should be met by an employee to successfully perform the essential functions of this job.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is regularly required to sit.
The employee frequently is required to manipulate or use objects, equipment, tools, and/or controls.
May require specific vision abilities to perform this job.
Ability to lift, carry or exert items or objects of reasonable weight.
WORK ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Attendance at employer worksite is an essential job requirement.
The noise level in the work environment is usually moderate.
For the most part ambient room temperatures, lighting and traditional office equipment as found in a typical office environment.
ADDITIONAL INFORMATION: The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.
The duties listed above are intended only as illustrations of the various types of work that may be performed. The omission of specific statements of duties does not exclude them from the position if the work is similar, related or a logical assignment to the position.
We are proud to be an EEO/AA employer M/F/D/V. We maintain a drug-free workplace and perform pre-employment substance abuse testing.