Manager, Case Management - Integrated Care - MyCare Institutional - Ohio

Job Summary:

The Manager, Case Management - Integrated Care is responsible for overseeing the Integrated Care Duals Product Teams in coordinating the care, service and health benefits for selected member populations.

Essential Functions:

Monitors and promotes safe and effective utilization of healthcare resources through clinical variance and benefits management

Actively manages the performance of the Integrated Care Management Liaisons and internal/external Care Management teams to ensure safe and effective service delivery, quality outcomes, and compliance with all state and accreditation requirements

• Assist in verifying eligibility, previous enrollment history, demographics and current health status of each member as appropriate
• Audit and review documentation gathered by internal staff and external partners to ensure thoroughness, accuracy and care management competency
• Contribute to the ongoing review of Member care plans, defining specific issues, goals and interventions as appropriate
• Responsible for ensuring that member/CM caseload ratios are kept at optimal levels
• Ensures that CM teams monitor and evaluate care plan effectiveness on an ongoing basis through member, family, provider, and stakeholder contact
• May assist Member liaisons in the facilitation and coordination of services based upon the care treatment plan developed in collaboration with all stakeholders

Working with peer Managers and Director, responsible for overall day-to-day Care Center operations, team coordination, and member outcomes, including, new staff orientation and scheduling, training, in-servicing, quality and performance improvement, regulatory and contractual compliance

Oversees effective care planning and implementation meeting member needs

Oversees the coordination of services with community partners to maximize utilization of appropriate community resources and supports, and assure effective and appropriate transitions between settings of care

• Works with Incident Management staff in the review and investigation of member incidents and/or issues related to member health and safety
• Works with Community Partners, Provider Relations and Network Management staff in the ongoing monitoring of quality issues for network providers
• Monitoring of scheduling/work allocation and productivity
• Provides quality monitoring  and conducts regularly scheduled one-on-one meetings with all team members
• Works with corporate staff in the follow up and review of member complaints and grievances
• Monitor and analyze Integrated Care Management data and reporting
• Assures overall compliance with the Integrated Care product model of care

Oversee and/or maintain current and accurate documentation of contacts, care treatment plans, case notes, referrals, and assessments in Care Management electronic record and within protocols and guidelines of the Care Management program

• Actively oversee the performance of the Integrated Care Management teams  to ensure all state and accreditation requirements are achieved
• Review and update all Care Management policies and Standard Operating Procedures
• May participate in meetings with providers to inform them of Care Management services and benefits available to members
• Serve as interdepartmental liaison and network with other departments to gather/share information about issues related to the Care Management process
• May assist in education of member/caregiver regarding healthcare access and benefits, and provide member/caregiver with health education and wellness materials
• Precept and/or mentor new staff
• Provide ongoing training, mentoring, coaching and disciplinary action as needed
• Participate in the hiring process of new Integrated Care Management personnel
• Provide guidance/instruction for Integrated Care Team Leads and other staff via formal and informal meetings
• Regular travel to conduct member visits, provider visits and community based visits as needed to ensure effective administration of the program
• Perform any other job duties as requested

Education and Experience:

• Bachelor’s Degree in Nursing, healthcare field, business administration or related field or equivalent years of relevant work experience required
• Minimum of five (5) years or more of clinical experience is required
• Minimum of three (3) years Medicaid and/or Medicare managed care or HCSB Waiver case management experience is preferred
• Three (3)  years  as a case manager is preferred
• Two (2) years of management experience is preferred

Competencies, Knowledge and Skills:

• Intermediate proficiency level of Microsoft Outlook, Word and Excel
• Ability to operate smart phone, iPad, or other mobile communication devices to ensure productivity and ability to perform essential functions
• Ability to communicate effectively with a very diverse group of individuals
• Ability to multi-task and work independently within a team environment
• Ability to collaborate with and effectively lead other team members to optimize outcomes for members
• Familiarity of the state and federal healthcare regulations and environment
• Awareness of community and state support resources for population served
• Critical listening and thinking skills
• Decision making and problem solving skills
• Proper grammar usage
• Strong organizational and time management skills
• Proper phone etiquette
• Customer service oriented
• Training/teaching skills
• Management and prior supervisory skills

Licensure and Certification:

Current, unrestricted license in the state of Ohio as a Registered Nurse (RN), Licensed Independent Social Worker (LISW), Psychologist, or Licensed Professional Clinical Counselor (LPCC)

Case Management certification is preferred

Employment in this position is conditional pending successful clearance of a driver’s license record check.  If the driver’s license record results are unacceptable, the offer will be withdrawn or, if  you have started employment in this position, your employment in this position will be terminated

To help protect our employees, members, and the communities we serve from acquiring communicable diseases, Influenza vaccination is a requirement of this position. CareSource requires annual proof of Influenza vaccination for designated positions during Influenza season (October 1 – March 31) as a condition of continued employment. Employees hired during Influenza season will have thirty (30) days from their hire date to complete the required vaccination and have record of immunization verified.

CareSource adheres to all federal, state, and local regulations. CareSource provides reasonable accommodations to qualified individuals with disabilities or medical conditions, sincerely held religious beliefs, or as required by state law to enable the employee to perform the essential functions of the position. Request for accommodations will be completed through an interactive review process.

Working Conditions:

Mobile Worker:  This is a mobile position, meaning that regular travel to different work locations is essential.  Will be exposed to weather conditions typical of the location and may be required to stand and/or sit for long periods of time

• Reside in the same territory they are assigned to work in; exceptions may be considered, due to business need
• May be required to travel greater than 50% of time to perform work duties.  A valid driver’s license, car, and insurance are necessary for work related travel
• Required to use general office equipment, such as a telephone, photocopier, fax machine, and personal computer
• Flexible hours, including possible evenings and/or weekends as needed to serve the needs of our member and may refer members to other CareSource resources