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

CareSource•Mobile, AL

1d•$83,000 - $132,800

About The Position

The Manager, Case Management - Integrated Care is responsible for overseeing Integrated Care Duals Product Teams in coordinating care, services, and health benefits for selected member populations. The role monitors utilization of healthcare resources and oversees care management teams to support safe, effective service delivery, quality outcomes, and compliance with state and accreditation requirements. The manager contributes to care planning and service coordination, monitors caseloads and team performance, and oversees day-to-day Care Center operations in collaboration with peer managers and the Director. The position also supports staff hiring, orientation, training, mentoring, coaching, and performance management; reviews documentation and policies; monitors program data and compliance; and collaborates with providers, community partners, and internal departments. This is a mobile position requiring regular travel, potentially more than 50% of the time, within the assigned territory. Flexible hours, including possible evenings and weekends, may be required. A valid driver’s license, car, and insurance are necessary for work-related travel. The role requires a current, unrestricted Ohio license as an RN, LISW, Psychologist, or LPCC. Employment is conditional on a satisfactory driver’s license record check, and annual influenza vaccination is required for designated positions during influenza season.

Requirements

Bachelor’s degree in Nursing, a healthcare field, business administration, or a related field, or equivalent years of relevant work experience.
At least five years of clinical experience.
Current, unrestricted Ohio license as a Registered Nurse (RN), Licensed Independent Social Worker (LISW), Psychologist, or Licensed Professional Clinical Counselor (LPCC).
Intermediate proficiency with Microsoft Outlook, Word, and Excel.
Ability to use a smartphone, iPad, or other mobile communication devices.
Ability to communicate effectively with a diverse group of individuals.
Ability to multitask and work independently within a team environment.
Ability to collaborate with and effectively lead team members to optimize member outcomes.
Familiarity with state and federal healthcare regulations and the healthcare environment.
Awareness of community and state support resources for the population served.
Critical listening and thinking, decision-making, and problem-solving skills.
Proper grammar and phone etiquette.
Strong organizational and time-management skills; customer-service orientation; and training and teaching skills.
Management and prior supervisory skills.
Successful clearance of a driver’s license record check is a condition of employment.
Annual proof of influenza vaccination is required for designated positions during influenza season; employees hired during the season have 30 days from hire to complete and verify vaccination.
A valid driver’s license, car, and insurance are necessary for work-related travel.

Nice To Haves

Three or more years of Medicaid and/or Medicare managed care or HCSB Waiver case management experience.
Three years of experience as a case manager.
Two years of management experience.
Case Management certification.

Responsibilities

Monitor and promote safe, effective utilization of healthcare resources through clinical variance and benefits management.
Manage the performance of Integrated Care Management Liaisons and internal and external Care Management teams to ensure effective service delivery, quality outcomes, and regulatory compliance.
Assist in verifying members’ eligibility, enrollment history, demographics, and health status as appropriate.
Audit and review documentation from internal staff and external partners for thoroughness, accuracy, and care management competency.
Contribute to review of member care plans and define issues, goals, and interventions as appropriate.
Maintain optimal member-to-case-manager caseload ratios.
Ensure teams monitor and evaluate care plan effectiveness through ongoing contact with members, families, providers, and stakeholders.
Assist member liaisons with facilitating and coordinating services based on care treatment plans developed with stakeholders.
Coordinate day-to-day Care Center operations and team activities, including staff orientation, scheduling, training, quality and performance improvement, and regulatory and contractual compliance.
Oversee effective care planning and implementation to meet member needs.
Coordinate services with community partners to maximize appropriate community resources and support transitions between care settings.
Work with Incident Management staff to review and investigate member incidents and health or safety issues.
Work with Community Partners, Provider Relations, and Network Management to monitor quality issues involving network providers.
Monitor scheduling, work allocation, and productivity; conduct quality monitoring and scheduled one-on-one meetings with team members.
Collaborate with corporate staff to follow up on and review member complaints and grievances.
Monitor and analyze Integrated Care Management data and reporting, and ensure compliance with the Integrated Care product model of care.
Oversee or maintain accurate documentation of contacts, care treatment plans, case notes, referrals, and assessments in the Care Management electronic record according to program protocols and guidelines.
Review and update Care Management policies and Standard Operating Procedures.
Participate in provider meetings to explain Care Management services and benefits when needed.
Serve as an interdepartmental liaison and share information about Care Management process issues.
Assist with educating members and caregivers about healthcare access and benefits, and provide health education and wellness materials when needed.
Precept or mentor new staff; provide ongoing training, mentoring, coaching, and disciplinary action as needed.
Participate in hiring Integrated Care Management personnel and provide guidance to Team Leads and other staff.
Travel to member, provider, and community-based visits as needed to support effective program administration.
Perform other job duties as requested.