Care Management Quality and Coverage Specialist CCM-Hybrid-Oneonta, Norwich, Binghamton, Cortland, Ithaca, Utica and Hamden
About The Position
The Care Management Quality & Coverage Specialist provides flexible support to the Care Management department by serving as a temporary or interim Care Manager when staffing vacancies, leaves of absence, caseload fluctuations, or other operational needs require additional coverage. When not providing direct caseload coverage, the position focuses on Care Management quality assurance activities, including review of Care Manager documentation, Life Plans, service provision, and other required records to support compliance, quality, consistency, and person-centered practice. This position serves as a resource to Care Management leadership by identifying documentation trends, areas of concern, opportunities for improvement, and potential training needs. The position requires strong knowledge of Care Management requirements, person-centered planning, OPWDD regulations and expectations, and the ability to effectively transition between direct service responsibilities and quality oversight functions. The Care Coordination Manager must meet the requirements of the Care Coordination Organization/IDD Health Home, including 6 core areas of Health Home requirements and skill building areas.
Requirements
- Bachelor’s degree with two years of relevant experience, or
- A Master’s degree with one year of relevant experience.
- License as a Registered Nurse with two years of relevant experience
- A valid Driver’s License
- Must be able to work a flexible schedule and use personal vehicle for business travel purposes.
- Ability to work with diverse populations and treat all people with dignity and respect
- Duties require professional verbal and written communication skills.
- Proficiency in or knowledge of using a variety of computer software and e-mail applications, especially Microsoft Excel, Outlook and Word; have the aptitude to learn other computer software as necessary.
Responsibilities
- Provide temporary Care Management coverage for individuals when a Care Manager position is vacant or when a Care Manager is unavailable due to extended leave, unexpected absence, or other staffing needs.
- Maintain required Care Management activities, contacts, documentation, assessments, Life Plans, service coordination, referrals, and follow-up during periods of coverage.
- Ensure continuity of Care Management services during transitions between Care Managers.
- Assist with onboarding or transition activities when a permanent Care Manager is assigned to a covered caseload.
- Conduct routine reviews of Care Manager case notes and documentation to assess completeness, timeliness, accuracy, and alignment with Care Management requirements.
- Review Life Plans and notes for person-centeredness, accuracy, consistency with identified needs, appropriate goals, safeguards, services, and identified supports.
- Identify patterns or trends in documentation, service provision, timeliness, and Care Manager practice.
- Track and communicate identified areas of concern to Care Management supervisors and leadership.
- Assist with targeted reviews of documentation when concerns, trends, complaints, incidents, or other quality issues are identified.
- Assist with audits and internal quality assurance activities as assigned.
- Provide feedback to Care Management supervisors regarding common documentation or practice issues identified through quality reviews.
- Assist in identifying training and coaching opportunities based on audit findings and observed trends.
- Support the development and implementation of tools, resources, and processes designed to improve Care Management practice.
- Serve as a resource to Care Managers regarding documentation standards, person-centered planning, service coordination, and Care Management expectations.
- Demonstrates a consistently positive, solution-focused approach by identifying opportunities for process improvement, contributing constructive ideas, and actively supporting a collaborative work environment while maintaining a constructive and solutions-oriented approach to challenges
- Maintain knowledge of applicable OPWDD, Health Home, Medicaid, Care Coordination Organization, and agency requirements applicable to Care Management.
- Utilize a variety of electronic systems to maintain documentation and communication.
- Ensure required training hours are completed.
- All employees must adhere to all HIPAA and IT Security policies.
- Other duties as assigned
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What This Job Offers
Career Level
Mid Level
