Supervisor Case Management

Community Health Plan of Washington • Seattle, WA

11h • $93,200 - $148,190 • 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
• 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. Essential functions listed are not necessarily exhaustive and may be revised by the employer, at its sole discretion.

Benefits

• Employees are expected to report to work as scheduled, participate in all assigned meetings, and meet established performance and accountability standards.

What This Job Offers

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