Manager Complex Health Clinical

CareSource

1d • $74,700 - $119,520 • Hybrid

About The Position

The Manager, Complex Health - Clinical is responsible for providing operational management and oversight to Care Coordinators, Clinical Care Managers and Service Determination employees dedicated to the Complex Health Clinical program. Individuals participating in the program are highly complex with diverse clinical needs. The Complex Health Clinical program considers the whole person as a collective and ensures the correct services are coordinated, approved and delivered with the highest quality.

Requirements

• Master’s degree in a Human Service Field is required
• Minimum of two (2) years of supervisory experience is required
• Valid licensure in the profession (social work, counseling or psychology) is required
• Excellent proficiency with Microsoft Office tools, including Project, Word, PowerPoint, Excel, Visio, Teams, Outlook, etc.
• Demonstrates analysis and reporting skills
• Excellent decision making/problem solving skills
• Exceptional interpersonal and relationship building skills
• Excellent critical listening and thinking skills
• Proven ability to effectively interact with all levels of the organization of management within and externally to the organization
• Excellent written and verbal communication skills
• Customer service oriented
• Proven ability to prioritize work and team assignments to deliver projects on time, on budget, and meeting stakeholders expectations
• Demonstrates a sense of urgency
• Strong experience in the Complex Population healthcare payer industry and knowledge of Medicaid and Medicare

Nice To Haves

• Five (5) years of post-degree professional experience is preferred
• Two years’ Care Coordination and/or Case Management and/or Utilization Review/Management experience preferred
• Experience with MH/IDD waivers preferred
• Basic knowledge of healthcare data coding such as CPT, HCPCS, ICD10, DRG and Revenue codes preferred.
• Experience operating HCBS/(b)(c) and (i) waivers preferred
• Valid licensure or certification in Substance Use preferred

Responsibilities

• Responsible for successful day to day operation of the Complex Health Clinical program
• Oversees a team of clinical and nonclinical staff to achieve quality service level and production expectations
• Manages and evaluates team member performance; provides coaching, counseling, employee development, and recognition; ensures ongoing, appropriate staff training; and has responsibility for the selection, orientation, and mentoring of new staff
• Maintains professional relationships with provider community, internal and external customers, and state agencies as appropriate, while identifying opportunities for improvement
• Utilizes available tools / platforms for efficiencies
• Ensures adequate staffing and service levels and maintains customer satisfaction by implementing and monitoring staff productivity and other performance indicators
• Ensures completion of staff quality audit reviews; evaluates services provided and outcomes achieved and recommends enhancements/improvements for programs and staff development to ensure consistent cost effectiveness and compliance with all state and federal regulations and guidelines
• Facilitate/promote problem identification, analysis, and resolution to improve member experience ensuring compliance with state and federal regulatory and accrediting standards
• Collaborate with Clinical Operations business owners to ensure members are getting the clinical care they require and that process are efficient and effective
• Collaborate with Analytics/IT when data is necessary for operations performance
• Review detailed reports to inform team performance
• Follow and teach Care Coordination, Service Determination and Utilization Management teams the CMS, State government regulations and NCQA requirements to ensure compliance
• Assist with the continuous improvement of Complex Health Clinical program best practices, processes, and tools
• Perform any other job duties as requested

Benefits

• 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager