Manager Integrated Care Management

Amerihealth Caritas•Southfield, MI

6d•Remote

About The Position

The Manager, Integrated Care Management, is responsible for leading the day-to-day operations of the Integrated Care Management team, overseeing the development, implementation, and performance of clinical care management programs. This role requires a strong understanding of care management, population health, and clinical operations, as well as knowledge of healthcare regulations and compliance requirements. The manager will also be responsible for budgeting, staffing, and change management within their area of responsibility.

Requirements

Bachelor’s degree in nursing or a related healthcare field required
Unrestricted licensed Registered Nurse (RN) in MI license
Master’s degree in social work with a current, unrestricted MI LMSW or LCSW license
8 to 10 years of progressive healthcare or managed care experience
5 years of leadership or case management leadership
1 year of project management experience required
Experience managing clinical operations, including budgeting, staffing models, and change management
Strong leadership and team management skills
In-depth knowledge of care management, population health, and clinical operations
Knowledge of healthcare regulations, standards, and compliance requirements
Ability to manage multiple programs and priorities in a fast-paced environment
Strong problem-solving skills
Creates and supports an environment that fosters teamwork, cooperation, respect, and diversity
Excellent communication and cross-functional collaboration abilities
Establishes and maintains positive communication and professional demeanor with associates, providers, and acts as liaison with outside entities as required
Demonstrates and supports commitment to corporate goals and mission
Proficient in program reporting and meeting deadlines
Proficiency with Microsoft Office tools (Excel, Word, PowerPoint)

Nice To Haves

Designation of Certified Case Manager is preferred

Responsibilities

Plans, organizes, and directs the development and implementation of clinical care management programs.
Ensure staff are adequately trained, oriented, and provided with regular professional development.
Identifies opportunities for improvement, both clinical and administrative, and assists the Director in strategic planning.
Coordinates the intake process for the new Care Management program and determines impacts, timelines, savings, etc.
Coordinates and implements the development of recommended policies.
Coordinates, establishes, and monitors achievement of departmental goals and objectives.
Responsible for collaborating with lines of business to assist in ensuring care management programs abide by all National Committee for Quality Assurance (NCQA) compliance standards and comply with all applicable state and federal laws.
Directs the effectiveness of existing programs and services.
Identifies and evaluates new programs and services to address cost-effectiveness, proposed process improvements, and compliance with NCQA and State-incentivized health outcomes.
Participates in and supports the corporate Medical Management Strategy.
Monitors monthly financial statements for the area of responsibility to determine and recommend adjustments.
Monitors and manages contractual compliance and regulatory requirements and reporting.
Facilitates effective communication both within and between departments to exchange information about quality of care, member concerns, and cost-efficient services.
Performs other duties as assigned.