Highmark Health Manager, LTSS Case Management in Wilmington, Delaware

Description

JOB SUMMARY

This job supervises a team of Case Manager Supervisors who are charged with promoting quality member outcomes, to optimize member benefits, and to promote effective use of resources. The incumbent ensures care is medically appropriate, high quality, and cost effective and is accountable for the oversight development and maintenance of the department's case management processes. This includes utilization management, strategic planning, care cost initiatives, system development and quality outcomes. Hires, trains, coaches, counsels, and evaluates performance of direct reports. Works closely with other departments within the corporation to resolve issues and to ensure activities coincide with case management processes. Supports an interdisciplinary approach to meeting members’ needs through a strong collaborative relationship with external stakeholders as well as internal departments including but not limited to Medical Directors, Behavioral Health Teams, Disease Management, and Utilization Review. The incumbent is accountable for special projects and enhanced activities within the department and accepts responsibility, in conjunction with the internal QA department, for meeting all reporting requirements as outline by the State of Delaware related to LTSS Case Management services.

ESSENTIAL RESPONSIBILITIES

  • Manage a team of Case Manager Supervisors.

  • Oversee the development of and updates to policies and procedures to support regulatory requirements related to Case Management.

  • Promote quality member outcomes to optimize member benefits and to promote effective use of resources while ensuring care is medically appropriate, high quality, and cost effective.

  • Oversee development and maintenance of the department's case management processes while ensuring compliance with regulatory agencies including but not limited to: NCQA, URAC, CMS, DOH, and DOL.

  • Promote strict adherence to all company, State and Federal requirements related to privacy practices, HIPAA, and quality performance standards.

  • Collaborate with other departments within the corporation to resolve issues and ensure activities coincide with Case Management processes.

  • Support an interdisciplinary approach to meeting members’ needs through a strong collaborative relationship with external stakeholders as well as internal departments including but not limited to Medical Directors, Behavioral Health Teams, Disease Management, and Utilization Review.

  • Accountable for special projects and enhanced activities within the department.

  • Meet all reporting requirements as outline by the State of Delaware related to LTSS Case Management services.

  • Monitor and track direct reports for completion of assigned work.

  • Provide service support, coordinating training and performance metrics/statistics to the team in addition to initiating and implementing process improvements.

  • Assist direct reports to problem solve escalated issues and identify and escalate issues appropriately.

  • Organize and facilitate staff meetings that ensure corporate and operational communication supported by meeting minutes; and provide an open forum for issues and problem solving.

  • Suggest new approaches to complex problems.

  • Set appropriate targets, measuring outcomes and establishing plans to negate variances in quality, staff retention, finance and customer satisfaction.

  • Ensure all staff achieve the minimal qualification of their position through ongoing staff development, counsel, individual and group education.

  • Manage and coordinate all department activities; staff education, policy and procedure development and revision, individual staff audits, oversee overall operations to ensure compliance to standards.

  • Recruit, select, orient, evaluate, counsel, and develop performance improvement plans; promote and terminate per corporate policy; and encourage career development and support of staff.

  • Develop and implement appropriate audit requirements in order to ensure compliance with all staff activity related to Case Management.

  • Maintain consistent and open lines of communication with internal and external customers.

  • Communicate changes in processes and programs order to enhance a share vision and mission.

  • Communicate outcomes, data analysis, complex processes and action plans to division/unit staff, corporate partners, and external customers.

  • Facilitate and lead informational and educational meetings for internal and external customers.

  • Coordinate, develop and implement department/division projects.

  • Perform other duties as assigned/requested.

QUALIFICATIONS

Required

  • Bachelor's degree

  • Current, valid, unrestricted license in one or more of the following disciplines: RN, LCSW, LSW, LPC, or other related clinical license

  • 5 - 7 years of clinical experience

  • 3 - 5 years of experience in case management/managed care

Substitutions

  • None

Preferred

  • Bachelor's degree

  • Current, valid, unrestricted license in one or more of the following disciplines: RN, LCSW, LSW, LPC, or other related clinical license.

  • Master's degree in a related human services field

  • 3-5 years management

  • One year in home clinical or case management experience

Skills

  • Leadership, collaboration, and motivational skills

  • Ability to multi task and perform in a fast paced, and often intense environment

  • Excellent written and verbal communication skills

  • Ability to analyze data, measure outcomes and develop action plans

  • Enthusiastic, innovative and flexible.

  • Team player that possesses strong analytical and organizational skill

  • The ability to prioritize work demands and meet deadlines

  • Proficiency in PC-based word processing and database documentation (Word, Excel, Internet, Outlook)

  • Ability to meet regulatory deadlines

  • Experience in workforce development and resource management with excellent team building and professional development skills

  • Medicare and Medicaid experience

  • Managed care experience

  • Experience in geriatric special needs, behavioral health, home health

  • Understanding of the importance of cultural competency in addressing targeted populations.

  • Experience with electronic documentation system(s)

  • Experience with cost neutrality and budgeting

SCOPE OF RESPONSIBILITY

Does this role supervise/manage other employees?

Yes

WORK ENVIRONMENT

Is Travel Required?

Yes

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement: This position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

REQNUMBER: J123192

Equal Opportunity Employer Minorities/Women/ProtectedVeterans/Disabled/Sexual Orientation/Gender Identity