Duties//Responsibilities:
Develops and monitors team goals; provides ongoing feedback and coaching; conducts annual performance reviews; leads by example; routinely evaluates staffs clinical skills and technical comprehension; and ensures an atmosphere of open communication, teamwork, and empowerment to make informeddecisions
Maintains and recommends appropriate staffing levels to guarantee safe and effective care management
Oversees continuation, coordination, and delivery of individualized care plans and authorized services
Collaborates with each Clinical Operations core areas as needed
Assists in analyzing reviews, metric data, and PHI audits and uses that information to identify opportunities for improvement
Additional duties as assigned
Minimum Qualifications:
Associates degree
NYS RN, LSW or other relevant clinical license
Preferred Qualifications:
CCM certification
Supervisory or training experience
Relevant clinical work experience
Knowledge of membersatisfaction//incident management and regulations
Knowledge of quality improvement methodologies
Demonstrated professionalism and leadership skills along with ability to develop, direct, and support a team
Time management, critical//creative thinking, communication, and problem-solving skills
Adept at planning, organizing, and executing
Knowledge of health insurance, Medicaid, Medicare and MLTCP
Care management experience in a clinical managed care environment and knowledge of best practices
Knowledge of UM//QM case philosophies and reporting requirements to state and federal agencies
Ability to allocate, monitor, and control resources while delegating and monitoring workloads
Ability to effectively manage performance as well as set and achieve goals
Compliance & Regulatory Responsibilities:
Ensures Care Management team meets department and regulatory requirements
Guarantees care plans are revised and updated according to regulatory requirements and as a members condition(s) changes in the multiple PHI databases, especially TruCare. Supervises and audits compliance including HIPAA standards, for confidentiality and management of PHI plus Care Management Team entries in varied electronic PHI storage systems (e.g.: Macess, TruCare, and EMR).
WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.