Supervisor, Case Management

Medica•Madison, WI

47d•Hybrid

About The Position

Medica is a nonprofit health plan with more than a million members that serves communities in Minnesota, Nebraska, Wisconsin, Missouri, and beyond. We deliver personalized health care experiences and partner closely with providers to ensure members are genuinely cared for. We're a team that owns our work with accountability, makes data-driven decisions, embraces continuous learning, and celebrates collaboration - because success is a team sport. It's our mission to be there in the moments that matter most for our members and employees. Join us in creating a community of connected care, where coordinated, quality service is the norm, and every member feels valued. The Supervisor, Case Management, is accountable for the day-to-day operational support and strategic activities of the assigned team. This position is also accountable for achieving department objectives and maintaining flexibility to meet business needs. Responsibilities include supervision of the clinical and non-clinical team members, ensuring that the strategic and business processes are established, maintained and communicated, and effective interdepartmental communications are established. This position resides in the Health Management department yet interacts regularly with other areas within Medica. In addition to the coaching and staff development responsibilities, the Case Management Supervisor must also build strong relationships with internal and external partners. More specifically, support the Manager, Case Management in relationship building within Medica and its vendor partners to help prioritize, integrate and coordinate interventions for population segments based on medical, behavioral and social needs. The supervisor will support the manager and work with staff to integrate and understand accreditation requirements and incorporate them into program activities.

Requirements

Bachelor's degree or equivalent experience in related field
5 years of work experience beyond degree
Registered Nurse with current licensure in the State of Minnesota or Wisconsin
RN License

Nice To Haves

Experience in a healthcare setting
Understanding of Medicare/Medicaid Programs from Minnesota/Wisconsin
Three to five 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, 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
Certified Case Manager (CCM) preferred or the ability to obtain within two years

Responsibilities

Supervise day-to-day team responsibilities: recruiting, hiring, training and team members. Audit team members for compliance against policies and procedures and NCQA audit requirements. Manage team members' workload and monitor staffing ratios. Provide performance appraisals and reward recognition.
Ensure that the Case Managers are accountable for engaging the members.
Facilitate assigned team meetings and work with Managers and Supervisors and leads for coordinated departmental team meetings, functions and responsibilities.
Provides support to Manager to run monthly reports for business segments and leadership on key performance targets including, engagement of members, productivity, closure of gaps in care, outcomes, satisfaction surveys and quality indicators.
Supervise and Maintain Efficient Department Operational Systems/Process
Comply with policy and procedures effectively and with appropriate documentation and ensure team meets all department, regulatory and accreditation requirements and goals
Informs the Manager of process, procedure, policy and other issues that cannot be resolved within the team
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 performance and hold staff accountable for meeting department standards for quality, turn around times, policy application, effectiveness, attendance, and personnel management, etc. Formulate action plan for less than acceptable performance
Consult human resources and manager to ensure compliance with company policies and values
Responsible for personnel management including interview process, goals establishment, performance review, and team-building
Assist with delivery of new employee orientation programs for team members, and contributes to the development, maintenance and communication of educational programs as indicated
Compile and report team and individual statistics for planning and evaluation
Assist the Manager to define and utilize performance standard to monitor staff performance
Accountable for driving performance toward goals and communicating effectively to peers when process gaps are impeding goals
Manage Performance of Multi-focused Team
Leads and supervises the program and team as outlined under the Position Overview section
Ensures that the team 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 meeting
Ensure timeliness and accuracy of all required administrative functions, i.e. timecards, performance evaluations, call recordings, expense reports, etc.,
Communicate management decisions in a positive manner to staff
Accessible during workday to facilitate problem solving and resolution of case review issues and complaints
Take phone calls, handle escalated issues and provide setting for clinical case consultations
Provide technical and clinical support to staff by researching and responding to their questions
Coach staff on the Quality Audit results. Recommendations from audits are evaluated and appropriate improvement measures are taken
Project and Group Management and Industry Knowledge
Work closely with project management team on implementation of new and renewing clients and for new and ongoing company and department initiatives
Exhibit skills in organization, project management, time management and meeting facilitation
Assist in the development, implementation or maintenance of department programs, which reflect quality of service and care as delegated by the manager
Represent Care Management at interdepartmental meetings and committees
Establish and Maintain Positive Relationships with Internal and External Customers
Assist in developing and maintaining strong, positive and open relationships with the employer groups and other internal and external stakeholders
Listen to and understand customers' questions, concerns or problems