Manager, Field Care Management

WellCare - Bowling Green, KY3.5

Full-timeEstimated: $77,000 - $110,000 a year
EducationSkillsBenefits
"PLEASE NOTE: THIS POSITION TO BE LOCATED IN ONE OF THE FOLLOWING LOCATIONS: LOUISVILLE, ASHLAND, BOWLING GREEN, HAZARD, OWENSBORO, OR LEXINGTON, KY"

Manages the day-to-day activities of the Field Care Management Team. Ensures the case management process of assessing, planning, implementation, coordination, monitoring, and evaluating services and outcomes is pursued to maximize the health of the Member. Promotes effective healthcare utilization, monitors health care resources and assumes a leadership role within the Interdisciplinary Care Team (ICT) to achieve optimal clinical and resource outcomes for member. Oversees the socio economic needs and services of selected member populations across the continuum of illness. Provides ongoing support and oversight to staff.

REPORTS TO: SR. DIRECTOR, FIELD HEALTH SERVICES

DEPARTMENT: KENTUCKY- HEALTH SERVICES STATE

POSITION LOCATION: LOUISVILLE, KY OR ASHLAND, KY OR BOWLING GREEN, KY, OR HAZARD, KY OR OWENSBORO, KY OR LEXINGTON, KY

Essential Functions:
Provides ongoing consultation to the care management team and reviews caseloads on an ongoing basis, both through regular face-to-face supervision sessions and review of management reports and deadlines.
Assists Medical Director and Dir, Field Service Coordination in creating department goals, objectives and metrics.
Oversees the implementation of programs and strategies.
Develops and implements case management workflows and policies & procedures.
Proactively monitors and tracks appropriate metrics to drive up efficiency.
Perform audits of assessments, care plans and service notes to verify cases are properly established and that member coordination activities are occurring and appropriately documented.
Coordinates team activities to meet contractual company deadlines and resolves interpersonal conflicts.
Partners & collaborates with other departments cross functionally regarding care and case management and/or Health Service initiatives.
Directs work assignments, measures results and initiates personnel actions as required.
Develops, implements and manages process improvement initiatives.
Monitors associate performance and conducts counseling/corrective action procedures when required. Identifies concerns, brings issues to management’s attention and offers suggestions for improvement.
Reviews time records, sets schedules and approves all vacation/time off requests for subordinate associates.
Provides training and guidance to new and current care management team regarding policy & procedure, systemic tools, workload and care/case plan development.
Answers all questions and assists peers and management with delegated tasks or projects.
Ensures compliance with all state and federal regulations as well as Corporate guidelines in day-to-day activities.
Performs special projects as needed.

Candidate Education:
Associate's Degree in Nursing, Health and Human Services or a related field is required
Bachelor's Degree in Nursing or Health Administration is preferred

Candidate Experience:
5 years of experience in case management, clinical acute care, home health, hospice, physician's office or public health is required
3 years of experience in managed care is required
1 year of management experience is required
NCQA, EQRO accreditation experience is preferred
Specialty Experience - In consideration of a specialty program or as a specific discipline leader i.e. Obstetrics, must have at least 5 years of experience or hold a national certification in that area of specialty (in states where applicable) is preferred

Candidate Skills:
Ability to communicate and make recommendations to upper management
Demonstrated time management and priority setting skills
Ability to lead/manage others
Ability to create, review and interpret treatment plans
Demonstrated negotiation skills
Demonstrated problem solving skills
Demonstrated interpersonal/verbal communication skills
Knowledge of community, state and federal laws and resources
Ability to effectively present information and respond to questions from families, members, and providers
Demonstrated written communication skills
Knowledge of healthcare delivery
Ability to multi-task
Demonstrated written communication skills
Ability to lead and manage others in a metric driven environment
Ability to implement process improvements
Knowledge of medical terminology and/or experience with CPT and ICD 10 coding

Licenses and Certifications:A license in one of the following is required:
Licensed Registered Nurse (RN) is required
Licensed Certified Social Worker (LCSW) is required
Licensed Clinical Mental Health Counselor (LCMHC) is required
Maintain required contact hours to fulfill regulatory requirements is required
Certified Case Manager (CCM) is preferred

Technical Skills:
Microsoft Excel is required
Microsoft Word is required
Microsoft Outlook is required
Healthcare Management Systems (Generic) is required