Senior Care Manager - Peak Health
About The Position
Reporting to the Manager of Care Management, the Senior Care Manager will be an integral member of the health plan’s medical management team. This position is responsible for onboarding new employees and mentoring members of the care management team, including providing education, performing documentation audits, and building clinical team members' expertise through direct feedback and real-time coaching. This position is committed to the constant pursuit of excellence in improving the health status of our members and community. This team member will have high organizational visibility and responsibility in ensuring overall excellence in all areas of care management.
Requirements
- Current Registered Nurse license issued by the state in which services will be provided or current multi-state Registered Nurse license through the enhanced Nurse Licensure Compact (eNLC).
- Five (5) years of healthcare clinical experience.
- Demonstrated knowledge of CMS regulatory and contractual documents; knowledge of Medicare Advantage, NCQA accreditation standards, disease management, utilization management, care management and discharge planning.
- Excellent written and oral communication.
- Problem solving capabilities to drive improved efficiencies and customer satisfaction.
- Attention to detail.
- Proficiency with Microsoft Office products.
- Ability to work under stressful working conditions.
- Meeting defined deadlines and deliverables is an imperative skill for this role.
Nice To Haves
- Bachelor's Degree in Nursing OR Associate of Science in Nursing Degree (ASN); Currently enrolled in a BSN program and BSN completion within three (3) years of hire.
- Management of Medicare and/or Medicaid populations.
- Five (5) years Care Management experience.
Responsibilities
- Participate in activities related to care management program build, implementation, oversight, and delegation.
- Utilizing NCQA documentation standards, performs audits of member records as part of care management oversight processes.
- Assists in the development and implementation of policies and procedures related to the Care Management process.
- Assists with monitoring performance standards, productivity and ensuring staff coverage to meet the needs of the department.
- Formulates, implements and evaluates educational strategies for staff.
- Maintains a working knowledge of the requirements of regulatory and compliance entities.
- Mentors new Care Managers and assists with training.
- Provides support and coaching to Care Managers and other clinical team members.
- Perform data collection and analysis of trends to determine areas of opportunity and strategies for better practices for the Care Manager team.
- Takes escalated calls or fills-in for the Care Manager team during high-peak periods.
- Assist in quarterly reporting of delegated case management processes to meet accreditation standards.
- Assist in submission of required documents/policies during application process to accrediting body.
- Provides clinical, procedural or interpretational assistance.
- Ability to present complex ideas and data to a wide variety of stakeholders from frontline employees to executive c-suite.
- Establishes and maintains cooperative and positive working relationships with key stakeholders across the organization.
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What This Job Offers
Job Type
Full-time
Career Level
Senior
Education Level
Associate degree
