Supervisor, Case Management

Medica•Madison, WI

5d•$78,700 - $118,020•Hybrid

About The Position

Medica's Case Management Supervisor provides operational leadership and strategic direction for an assigned case management team, ensuring effective daily operations and alignment with departmental goals. The role oversees clinical staff, supports integrated, evidence-based care management practices for maternal, pediatric, complex, and behavioral health populations, and collaborates across the organization to improve member outcomes. The supervisor supports hiring and staff development, quality improvement initiatives, project oversight, monitoring performance and utilization data, and reporting insights to internal stakeholders, while assisting with the implementation of innovative care management models and interventions for high-risk, high-cost populations. The role also partners with internal leadership and stakeholders as well as external vendors to coordinate resources that address members' medical, behavioral, and social needs. A key responsibility is supporting accreditation and regulatory compliance by integrating accreditation standards into program operations and ensuring appropriate documentation of program plans, outcomes, and performance measures. This role promotes a culture of customer service, collaboration, accountability, and continuous improvement. Success in this role requires strong leadership, relationship management, change facilitation, and a commitment to Medica's core values.

Requirements

Associate or Bachelor’s degree in Nursing
5 years of related work experience
Current, unrestricted RN
Certified Case Manager (CCM) preferred, or ability and commitment to obtain within two years of hire required
1+ years of leadership experience.
Experience in a healthcare setting.
3-5 years experience and expertise in communicating with staff in different positions and all levels of management positions.
Excellent customer service skills and proven team building skills.
Excellent computer skills including Microsoft Word, Outlook, Power Point and Excel.
High degree of initiative and ability to work independently and within a group.
Demonstrated effective project management skills, including use of project planning and tracking tools; development of achievable goals, objectives, and timelines; and innovative use of resources.
Ability to plan, organize and prioritize work effectively, including the flexibility to accommodate frequent changes.
Strong problem-solving skills.
Knowledge of NCQA accreditation, Motivational Interviewing, Evidence Based Medicine and coaching.
Consultant skills to articulate business needs and translate to quality programs that result in targeted staff competencies.
Strong leadership skills.

Nice To Haves

Certified Case Manager (CCM) preferred

Responsibilities

Overseeing the daily responsibilities of the team, including recruiting, hiring, and training staff.
Ensuring that team members are compliant with internal policies, procedures, and NCQA audit standards through regular audits and performance monitoring.
Managing workloads, monitoring staffing ratios, and conducting performance appraisals, while also recognizing and rewarding strong performance.
Leading team meetings and collaborating with managers, supervisors, and team leads to coordinate departmental meetings, functions, and responsibilities.
Developing job descriptions and setting performance goals for team members, while providing budgetary consultation to support program operations and ensure they remain within established financial parameters.
Ensuring that Case Managers are actively engaging members, their provider care teams, and Medica’s care management resources.
Implementing care plans and supporting transitions in care that promote member self-management and clearly define accountability across the member’s support network.
Supervise and Maintain Efficient Department Operational Systems/Process
Ensure team compliance with all policies, procedures, and documentation standards, as well as departmental, regulatory, and accreditation requirements.
Escalate unresolved issues related to processes, procedures, or policies to the Manager.
Model change management philosophies and support and facilitate a positive approach to change among team members.
Monitor team members’ calls and casework to ensure staff is following department guidelines, processes and turn-around times.
Manage team performance and hold staff accountable for meeting standards related to quality, timeliness, policy compliance, effectiveness, attendance, and conduct.
Develop and implement action plans for staff whose performance does not meet expectations.
Collaborate with Human Resources and the Manager to ensure all personnel actions align with company policies and values.
Oversee personnel management activities, including interviewing, goal setting, performance reviews, and team-building efforts.
Assist in delivering new employee orientation and contribute to the development and communication of ongoing training and education programs.
Compile and report team and individual performance statistics to support planning and evaluation.
Support the Manager in defining and applying performance standards to monitor staff effectiveness.
Drive team performance toward departmental goals and communicate process gaps that may hinder progress to peers and leadership.
Manage Performance of Case Management Team
Leads and supervises the program and team as outlined under the Position Overview section.
Ensures that the Case Manager’s successfully meets and exceeds process-oriented outcomes.
Assess the training and development needs of each new employee to result in fully competent performance within one year. Assess existing employees for training and development needs or performance improvement plans.
Provide team members with ongoing and consistent feedback, directed toward clinical excellence and accountability to department goals.
Regularly assess and measure team workload and staffing ratios, ensure workload is evenly distributed. Develop and implement plan for backlog situations when needed. Communicate workload and turn-around times.
Coach, encourage and facilitate individual growth and development through specific, timely and consistent feedback. Conduct regular and timely one-on-one meetings.
Ensure timeliness and accuracy of all required administrative functions, i.e. timecards, performance evaluations, call recordings, expense reports, etc.
Communicate and support management decisions in a positive manner to staff.
Be available to resolve issues, take escalated calls, and support case reviews.
Provide technical and clinical support to staff by researching and responding to their questions.
Coach staff on the Quality Audit results. Ensure recommendations from audits are evaluated and appropriate improvement measures are taken.
Performs other duties as assigned.