Manager - Care Management

Description

• Put Patients First
• Empower Entrepreneurial Provider and Care Teams
• Operate with Integrity & Excellence
• Be Innovative
• Work As One Team

What You'll Do

• Manage clinical services, including oversight of clinical policies, procedures, and daily activities of clinical team staff
• Ensure adequate staffing to conduct care management activities and effectively distribute workloads
• Ensure team members receive appropriate training to serve the population and demonstrate effective engagement activities for individuals with various disabilities, including chronic physical and behavioral health conditions
• Ensure Integrated Clinical Services staff are trained on NCQA and HEDIS measures and processes to maintain compliance
• Ensure all programs and clinical operations are in full compliance with state and federal regulations, including HIPAA
• Ensure compliance with emergency management policies, procedures, and processes by serving as a liaison with other business units
• Monitor the effectiveness of existing procedures and outreach/intervention efforts in demonstrating positive outcomes for patients
• Ensure appropriate care planning, education, and interventions are conducted for members identified as at risk
• Ensure staff coordinate the exchange of information between behavioral health and medical providers in developing comprehensive care plans for at-risk members
• Monitor data to address quality measures, trends, and improvement opportunities, including provider issues, service gaps, and patient needs
• Evaluate the effectiveness of care management programs and implement adjustments when opportunities for improvement are identified

Qualifications

• Bachelor's degree in Nursing or a related field, or graduation from an accredited School of Nursing
• Licensed in Rhode Island; additional Massachusetts RN license preferred
• At least 3 years of care management and/or utilization management experience
• In-depth knowledge of assessment, diagnosis, and treatment of individuals with complex needs
• Strong understanding of care management, mental health community resources, and local healthcare delivery systems
• Experience leading a functional area, managing cross-functional teams on large-scale projects, or providing direct supervisory leadership, including hiring, training, work assignment, and performance management
• Effective written and verbal communication skills
• Extensive experience with Microsoft Office Suite, including Word, Excel, and PowerPoint
• Professional work ethic and strong attention to detail
• Ability to thrive in a fast-paced environment
• Authentic passion for improving the lives of complex, high-risk patients and advancing value-based care

• Massachusetts RN license
• Experience supporting integrated care management programs for high-risk populations
• Experience working within managed care, health plan, or value-based care environments

• Active RN, LMSW/LCSW, LMFT, LPC, PhD, or PsyD license in the applicable state
• Rhode Island licensure required

Environmental Job Requirements and Working Conditions

• This is a full-time position supporting telephonic and in-home Care Management services for high-risk patient populations
• Ability to work in a fast-paced environment while managing multiple priorities and deadlines
• Occasional local travel may be required to support business and patient care needs
• Frequent use of a computer, telephone, and standard office equipment
• Must maintain compliance with all HIPAA, state, and federal regulations
• Ability to work independently and collaboratively across multidisciplinary teams
• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the role.