Care Management Clinician Team Lead

PacificSource•Boise, ID

About The Position

Accountable for the effective management of Clinical Care Managers for all or assigned lines of business. The role is responsible for hiring, training, coaching, counseling, and evaluating team members, and may also perform routine day-to-day program functions. The Team Lead participates in program development and implementation, supervises and guides direct reports and other department staff on company policies and operations, and manages team quality, productivity, workflow, and outcomes. The position works to resolve issues and improve processes, and maintains a modified caseload consistent with assigned responsibilities. The role provides leadership for assigned programs, services, or functions; oversees team performance and daily workflow; trains and evaluates staff; and monitors assignments for volume, timeliness, accuracy, customer service, and quality. It supports continuous process improvement, coordinates with other departments and community partners, serves on committees, communicates relevant information to the team, helps resolve process issues and conflicts, and supports exceptional service for members and other internal and external customers. The position is based in a general office setting with ergonomically configured equipment and requires approximately 5% travel.

Requirements

At least five years of clinical experience, including case management experience.
Active, unrestricted Registered Nurse (RN) license, Licensed Professional Counselor (LPC), Licensed Marriage and Family Therapist (LMFT), or Licensed Clinical Social Worker (LCSW) credential.
Certified Case Manager (CCM) certification accredited by CCMC, required at hire or within two years of hire.
Knowledge of health insurance and state-mandated benefits.
Thorough knowledge and expertise in case management practice, including advocacy, assessment, planning, communication, education, resource management, and service facilitation.
Effective adult education/teaching and/or group leadership skills.
Ability to work effectively with people who have varied health issues and concerns.
Strong analytical and organizational skills, including experience using information systems and computer applications.
Ability to develop, review, and evaluate utilization and case management reports.
Strong computer skills, including experience with Word, Excel, and PowerPoint, and ability to use audio-visual equipment.
Ability to work independently with minimal supervision.
Demonstrated flexibility.
Skills in accountable leadership, collaboration, written and verbal communication, critical thinking, decision-making, influencing, active listening, and organization/planning.
Ability to stoop and bend; sit and/or stand for extended periods; perform repetitive typing, sorting, and filing; and lift and carry files and business materials weighing up to a light load.
Ability to read and comprehend written and spoken English and communicate clearly and effectively.

Nice To Haves

At least three years of direct health plan experience in case management, utilization management, behavioral health, and/or disease/condition management.
Prior supervisory experience.

Responsibilities

Lead the development, implementation, operation, and maintenance of assigned programs, services, or functions.
Oversee and coach team members to improve department performance, processes, and outcomes.
Monitor daily workflow, caseloads, and team work processes to ensure appropriate task distribution and processing.
Orient and train new hires; provide ongoing supervision, training, evaluation, and leadership to assigned team members.
Participate in hiring decisions with the Director and/or Health Services Manager and Human Resources; may be involved in annual reviews, promotions, and terminations.
Monitor team assignments and take action related to volume, timelines, accuracy, customer service, and other quality and performance measures.
Assist with process improvement and collaborate with other departments to improve interdepartmental processes, using lean methodologies and visual boards to monitor key performance indicators and identify improvement opportunities.
Serve as a liaison with other PacificSource departments and community partners to coordinate service and information.
Serve on internal and external committees as required or designated, and report pertinent communications to the team or department.
Use and promote evidence-based tools, and maintain a modified caseload consistent with assigned responsibilities.
Facilitate investigation and resolution of process-related issues and conflicts, including coordination with affected departments and individuals.
Oversee and assist with providing service and information to members, providers, employers, agents, and other customers.
Model effective written and verbal communication and provide backup to other departmental teams or management staff as needed.
Meet department and company performance and attendance expectations.
Communicate new or revised policies, procedures, and processes to team members.
Facilitate team operations through information sharing, identification of teamwork issues, problem-solving recommendations, and recommendations for standardizing Health Services operations.
Represent the Health Services Department internally and externally as requested by the Health Services Manager and/or Director.
Perform other duties as assigned.