Supervisor, Restricted Recipient Program (Case Management)

Medica•Minnetonka, MN

3d•$78,700 - $134,900•Hybrid

About The Position

Medica is a nonprofit health plan serving over a million members across several states. This position is accountable for the day-to-day operational support and strategic activities of the assigned team, ensuring the achievement of department objectives and maintaining flexibility to meet business needs. Responsibilities include supervising clinical and non-clinical team members, establishing and maintaining strategic and business processes, and ensuring effective interdepartmental communication. The role participates in the planning, implementation, and evaluation of the restricted recipient program to ensure quality services and compliance with regulatory and contractual requirements. This position resides within the Health Services department but interacts regularly with other areas within Medica. The Supervisor will also build strong relationships with internal and external partners, support the Director or Manager, Case Management in relationship building within Medica and its vendor partners, and help prioritize, integrate, and coordinate interventions for population segments based on medical, behavioral, and social needs. This role oversees case management projects, initiates and participates in quality improvement activities, and performs data monitoring of utilization activity for reporting to internal customers. Other duties as assigned.

Requirements

Associate's or Bachelor's degree in Nursing
5+ years of related work experience beyond degree
1+ years in leadership
Active, unrestricted RN License or SW License in the state of MN Required
Certified Case Manager (CCM) preferred, or ability and commitment to obtain within two years of hire.
Experience working with vulnerable and complex populations in a clinical, home care or telephonic environment; direct case management experience strongly preferred.
Experience and at ease working with various populations: multiple age groups, ethnic and socioeconomic backgrounds, medical, surgical backgrounds and a generalized level of understanding across specialty care areas.
Experience managing multiple computer systems and tools.
Proven experience in case management, healthcare operations, or a related field.
Strong leadership, coaching, and team development skills.
Eligibility to work in the US: Medica does not offer work visa sponsorship for this role. All candidates must be legally authorized to work in the United States at the time of application. Employment is contingent on verification of identity and eligibility to work in the United States.

Nice To Haves

Certified Case Manager (CCM) preferred, or ability and commitment to obtain within two years of hire.

Responsibilities

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 contractual requirements and goals.
Inform the Manager/Director 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/Director 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/Director 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 Restricted Recipient Team.
Ensure that the coordinators successfully meet and exceed 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 a 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.
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 the Restricted Recipient program 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 other internal and external stakeholders.
Listen to and understand customer’s questions, concerns or problems.