About this opportunity
CareSource lists this Manager, Case Management RN- Integrated Care opportunity in mobile, Alabama. Review the employer’s description below for duties, qualifications and application requirements.
Job description
Manager, Case Management - Integrated Care
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
Compensation Range:
$74,700.00 - $119,520.00
CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type (hourly/salary):
Salary
Organization Level Competencies:
Fostering a Collaborative Workplace Culture
Cultivate Partnerships
Develop Self and Others
Drive Execution
Influence Others
Pursue Personal Excellence
Understand the Business
Worksite address
mobile, AL, 36624, US
Who can apply
Review the original listing for work authorization, qualifications and employer requirements.