Manager, Case Management
4 weeks ago
**Profile**:
Veterans, Reservists, Guardsmen and military family members are encouraged to apply
We offer remote work opportunities (AK, AR, AZ, CA, *CO, FL, HI, IA, ID, IL, KS, LA, MD, MN, MO, MT, NE, NV, NM, NC, ND, OK, OR, SC, SD, TX, UT, VA/DC, *WA, WI & WY only)
**Job Summary**
This position oversees Case Management and related care coordination programs. Under the direction of the department Director, the Manager develops and implements policies and procedures for programs provided under Case Management. The Manager is accountable for department performance and facilitates collaboration with external entities such as network providers, customer staff and community-based programs.
**Education & Experience**
**Required**:
- Bachelor's degree in Nursing or related field or equivalent experience o Current unrestricted RN license in the appropriate state or territory of the United States o Must obtain a URAC-recognized Case Management certification within 2 years of hire o 2 years case management and program management experience o 2 years supervisory or management leadership experience in a healthcare environment
**Preferred**:
- Master's degree in Nursing or related field o Military or Veteran Health experience o URAC-recognized Case Management Certification upon hire o 2 years’ experience providing direct clinical care to patients
**Key Responsibilities**
- Supervises the program staff consistent with contracts, budgets and program regulations. o Selects, trains, coaches, and developments staff to ensure quality control and compliance with professional standards, Case Management Policies, Desk Procedures, contract requirements.. o Assesses effectiveness of training curriculum and supports Director with development initiatives. o Educates Case Management staff regarding URAC and/or other accreditation standards and changes to ensure compliance. Develops action plans to keep process in compliant with standards. o Develops documentation standards and templates for program-specific communications regarding program referrals, authorizations in collaboration with other TriWest departments. o Assists in the development of culturally competent tools and materials for Veteran education regarding clinical and psychosocial topics as well as Case Management. o Collaborates with VAMC and VACO staff, internal TriWest staff and other external referral sources on Case Management programs. o Manages outpatient care coordination for Veterans who do not opt in to case management, including program registration, enrollment, authorizations, and screening for special risk factors.
- Conducts case review program that includes audits to assure consistency and compliance with program registration, authorizations, and documentation processes, and implements program processes improvements. o Keeps the management team updated on significant issues. Assists in the preparation and presentation of cases for physician consultation and guidance involving high-profile or sensitive issues. o Provides oversight and direction for developing reporting tools for Case Management.. o Participates as a leader in the development, maintenance, and improvement of internal standards, desk procedures, and protocols. Ensures quality outcomes and compliance with other TriWest and customer specific policies and procedures. Supports TriWest initiatives for process improvement. o Collaborates with TriWest staff on Case Management issues, including Provider Services, Provider Education, Marketing, External Communications and Operations. Collaborates with Correspondence and Customer Relations to resolve customer complaints. Responds to VAMC or VACO service inquiries. o Participates in cross-functional teams for corporate projects. o Performs other duties as assigned.
**Competencies**
**Coaching / Training / Mentoring**:Actively foster actions required for desired business outcomes through ongoing constructive feedback.
**Coping / Flexibility**:Resiliency in adapting to a variety of situations and individuals while maintaining a sense of purpose and mature problem-solving approach is required.
**Empathy / Customer Service**:Customer-focused behavior; Helping approach, including listening skills, patience, respect, and empathy for another's position.
**Independent Thinking / Self-Initiative**:Critical thinkers with ability to focus on things which matter most to achieving outcomes; Commitment to task to produce outcomes without direction and to find necessary resources.
**Leadership**:Successfully manage different styles of employees; Provide clear direction and effective coaching.
**Multi-Tasking / Time Management**:Prioritize and manage actions to meet changing deadlines and requirements within a high volume, high stress environment.
**Organizational Skills**:Ability to organize people or tasks, adjust to priorities, learn systems, within time constraints and with available resources; Detail-oriented.
**Problem Solving / Analysis**:Ab
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