Supervisor Case Management

CHPW•Seattle, WA

13h•Onsite

About The Position

Provides clinical and administrative leadership to care management team(s). Responsible for direct daily oversight of both medical and behavioral health clinicians and non-clinical staff in the delivery of care management services to identified Plan members with a range of physical health, behavioral health and social service needs. Implements care management programs and ensures program operations and documentation support regulatory standards.

Requirements

Bachelor’s degree in nursing or a master’s degree in social work and/or a related behavior health field required.
Current, unrestricted RN license in the State of Washington OR Current, unrestricted LICSW license in the State of Washington required
Case Management Certification required or obtained with the first 2years of employment.
Minimum of three (3) years clinical experience in an acute care or public health setting, AND a minimum of three (3) years as a case manager in a Accountable Care Organization (ACO), Managed Care Organization (MCO) , or Behavioral Health Organization (BHO) required
Complete and successfully pass a criminal background check
Has not been sanctioned or excluded from participation in federal or state healthcare programs by a federal or state law enforcement, regulatory, or licensing agency
Knowledge of substance abuse recovery and mental health care models
Ability to meet scheduled deadlines with minimal supervision
Effective verbal and written communication skills
Flexibility and willingness to work in a matrix-management environment
Demonstrated organizational and time management skills
Ability to handle multiple priorities in a fast-paced environment
Ability to multi-task assignments on a frequent basis
Demonstrated proficiency and experience with Microsoft Office products
Knowledge of regulatory and certification requirements and their impact on the organization (for example, HEDIS, CAHPS, and NCQA)
Ability to work independently
Collaborate with others in a respectful manner
Perform all functions of the job with accuracy, attention to detail and within established timeframes
Meet attendance and punctuality standards
Demonstrate professional courtesy to others and ability to maintain confidentiality

Nice To Haves

Three (3) years supervisory or leadership experience in a healthcare or managed care setting preferred
Experience with Washington state Medicaid requirements, CMS Medicare care management, and special needs plan (SNP) requirements preferred
Knowledge in criteria set, including Milliman and InterQual, preferred

Responsibilities

Prioritizes daily workflows, assignments and triage priorities to meet state and Federal regulatory requirements and established organizational performance metrics.
Monitors performance and productivity of team and team members to ensure guidelines are followed and goals are met.
Facilitates collaboration with internal partners for a coordinated approach to care coordination for members.
Supports regionalized care team structure to coordinate care across IMC regions.
Responsible for a strong understanding of health plan benefits for assigned line(s) of business.
Participates in Care Management Rounds to support a productive and collaborative discussion and provide clinical input on cases.
Responsible for onboarding new staff and monitoring performance to ensure competency of new skills.
Conducts staff audits according to internal policies and procedures in order to identify opportunities for improvement and alignment with program expectations.
Assists in the development of team metrics; implements workflows to achieve assigned metrics.
Utilizes data to monitor clinician productivity.
Assists management in the identification, implementation, and maintenance of standardized operations to ensure compliance standards are met.
Works with management to establish efficiency and quality standards for the team; conducts routine audits and uses data to drive performance improvement.
Reviews quality audits and shares results with associates in a timely manner; provides education and coaching to improve performance as needed.
Ensures that staff are adequately trained to achieve goals and outcomes for the program. This includes onboarding new staff and ongoing training for existing staff.
Assists in performing direct member outreach and care management activities as needed to support staff and the team.
Other duties as assigned.