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Job description
Description
This position oversees operational activities of the Care Management area of the Medical Management department. This includes program development and monitoring, staff development including overseeing frontline supervisors. This position assists in developing and operationalizing new programs and ensures regulatory and contractual requirements are met.
Duties and Responsibilities
Responsibilities include, but are not limited to the following:
Develops, executes and evaluates work plan for area of responsibility
Ensures ongoing monitoring, evaluation, and outcome measurement for all Case Management (CM) programs
Provides regular reports and presentations on clinical outcomes of CM programs
Identifies opportunities and cost/benefit for new CM programs and enhancements to existing programs, using data analysis tool
Assists with developing case management programs for new lines of business
Provides supervision, direction and guidance to team while serving as the subject matter expert and lead on functional deliverables
Provides performance feedback and coaching to staff, as well as makes hiring and termination decisions
Assist in the training of new staff and providing an environment of continuous learning for existing staff
Sets performance standards and productivity measures for direct reports
Professional development of staff, including identification of educational opportunities, annual performance appraisals and goal development
Determines/monitors staffing ratios
Develops and ensures consistency in CM documentation standards
Works with Clinical Trainers in the development of comprehensive role specific orientation/training programs
Manages the development of CM policies and procedures and ensures annual review and revision
Collaborate with Chief Medical Officer and Medical Director on new and existing clinical programs
Serves as organizational consultant for CM performance practice
Participates in administrative budget development and monitoring for area of responsibility
Identifies and recommends opportunities for improvement and implements process improvement activities
Representative of CM programs with state and community partners
Collaborate with Matrix partners to develop, maintain and evaluate programs
Other duties as assigned
Qualifications
Qualifications :
Required:
Active, unrestricted Rhode Island Nursing OR Licensed Independent Clinical Social Worker (LICSW) license in good standing. (Consideration will be given to individuals without current RI license. Must provide documentation confirming RI RN or LICSW application within 24 hours of offer)
Bachelor degree in health related field or in lieu of degree; Associate degree in Nursing with seven (7) years or more in supervisory role
Five (5) + years' experience in field of clinical, managed care and/or operational management
Five (5) + years supervisory experience
Strong collaboration, interpersonal and leadership skills
Strong oral and written communication skills
Strong analytical skills
Proven ability to develop innovative programs and services
Well-developed organizational and planning skills
Ability to independently problem solve
Intermediate to Advanced skills in Microsoft Office (Word, Excel, PowerPoint, Outlook)
Ability to work extended hours including evenings, nights and weekends
Preferred:
Masters degree
Certification as a Case Manager from an accredited Case Management program
Knowledge of state agencies and community family support resources
Bilingual
Neighborhood Health Plan of Rhode Island is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.
Who can apply
Review the original listing for work authorization, qualifications and employer requirements.