Sr. Manager, Clinical Care Management

RESPONSIBILITIES: Lead, mentor, and manage a team of clinical care managers, nurses, social workers, and other healthcare professionals. Provide coaching, training, and professional development opportunities for team members. Conduct performance evaluations, identify skill gaps, and support ongoing education and improvement initiatives. Develop and implement effective clinical care management strategies that support client needs and ensure optimal patient outcomes. Oversee care coordination processes, including chronic disease management, discharge planning, and transitions of care. Design and manage care plans that align with evidence-based practices, regulatory standards, and client-specific goals. Serve as the primary point of contact for clients, ensuring alignment of care management initiatives with their objectives and expectations. Collaborate with clients to assess needs, provide recommendations, and adjust care management plans as necessary. Monitor client satisfaction and resolve any issues or concerns related to care management services. Ensure compliance with relevant healthcare regulations, standards, and quality benchmarks, including HIPAA, accreditation requirements, and client-specific guidelines. Implement processes to track patient outcomes, satisfaction, and service delivery metrics, providing regular reports to senior leadership and clients. Identify areas for process improvement and lead quality improvement initiatives within the care management team. Analyze data related to patient outcomes, utilization, and care management performance to provide actionable insights to internal teams and clients. Generate reports and conduct presentations to senior management, clients, and stakeholders on clinical care management performance and improvement efforts. Work closely with other departments such as medical, operational, and IT teams to ensure integrated and efficient care management processes. Coordinate with external healthcare providers, specialists, and vendors to ensure continuity of care and optimal treatment outcomes for patients. Oversee and manage the care management department’s budget and resource allocation, ensuring cost-effective delivery of services. Identify and implement strategies to reduce costs while maintaining high standards of patient care. Stay up-to-date with industry trends, emerging clinical best practices, and regulatory changes. Drive innovation and continuous improvement initiatives within the clinical care management function. QUALIFICATIONS: A bachelor’s degree in nursing, Social Work, Healthcare Administration, or a related field is required. A Master’s degree is preferred. Relevant clinical certifications (e.g., RN, LCSW) required. Certification in Case Management (CCM) or equivalent is preferred. A minimum of 5-7 years of experience in clinical care management, case management, or healthcare consulting, with at least 3 years in a leadership or managerial role. Experience in managing teams, overseeing care plans, and working with healthcare providers or payers is highly desirable. Demonstrated ability to manage complex healthcare programs and deliver measurable outcomes. Strong leadership and team management skills, with the ability to coach, motivate, and inspire staff. Exceptional knowledge of clinical care management best practices, healthcare regulations, and patient-centered care. Ability to work effectively with clients, both internal and external, and manage multiple stakeholder relationships. Analytical mindset with strong problem-solving and decision-making capabilities. Excellent communication, interpersonal, and presentation skills. Proficient in healthcare management software, electronic health records (EHR), and data analytics tools. Moderatedegreeofmental/visualstressinvolved.ConcentratedperiodsoftimespentusingPC keyboard and viewing monitor. Will work some weekends, evenings or early hours to accommodate member needs. Medicalincs is an Equal Opportunity Employer and does not discriminate on the basis of race, creed, color, religion, gender, sex, sexual orientation, gender identity, pregnancy, national origin, citizenship status, age, disability, medical condition, genetic information, marital status, status as a covered veteran, military discharge status, criminal records that have been sealed or expunged, arrest records not resulting in conviction or any other characteristic protected by federal, state and/or local law. #J-18808-Ljbffr