Care Management Team Lead
4 weeks ago
Job Summary
The Manager is responsible for overseeing the Care Management Teams within the Health Management Department. This position ensures that care management clinicians and specially trained support staff are an integrated team available and prepared to coordinate care services for the populations served. The Manager maintains oversight of care management intake and referral activities, the assignment of cases for coordination, and proactive outreach for care management programs. They have a day-to-day awareness of each team's case load, and performance ensuring consistency of decision making, quality of service, and cost containment. The Manager monitors team initiatives to meet departmental and organizational goals and objectives in support of the Health Plan's successful achievement of the Triple Aim. They assist in the development of new care management programs based on the needs of MPHC's member population as well as assist with coordinating and monitoring care management for Medicare Special Needs plans. As an active member of the Health Plan leadership team, the Manager will serve as a subject matter expert with specific focus on mentoring new team members, assisting with training and development, and providing guidance and support.
Key Responsibilities
Ensures that the care coordination programs are aligned with current industry evidence-based practice, as well as local, national and regulatory compliance standards.
Maintains a detailed knowledge of applicable regulatory and accrediting body standards (i.e. American Nurses Association (ANA), Case Management Society of America (CMSA), National Committee of Quality Assurance (NCQA), Centers of Medicare and Medicaid Services (CMS)) and assists all staff members to maintain compliance.
Manages the day-to-day care coordination operations of the Health Management Department including but not limited to discharge planning, transitions of care, routine and complex care management and collaboration with providers and community resources.
Regularly monitors population health data to ensure that members receive appropriate care coordination services based on the needs of the population that MPHC serves.
Determines appropriate staffing requirements and develops and monitors metrics to ensure team accountability and performance and drive business performance.
Develops and manages strategies and programs designed to expand care coordination services to reach members in a timely manner with valuable interventions.
Participates in technology, system planning and enhancement; recommends and tracks technology modifications that support the care coordination programs. Makes supervisory decisions that are consistent with HR policies and procedures.
Ensures CM staff have all required resources necessary to effectively perform assigned duties.
Assists the director with budget activities and helps to forecast FTE and other resource needs to ensure efficient CM operations.
Serves as clinical department representative in Plan committees, focus groups and other strategic and operational interdepartmental initiatives.
Collaborates with other department managers and team members to achieve departmental and organizational goals.
Identifies opportunities for process improvement and initiates or delegates projects.
Ensures compliance with and integrity of all departmental processes and policies with contractual, regulatory, and accreditation requirements.
Develop and implement staff training, including onboarding, systems, and guideline usage in order to standardize processes and procedures.
Assists with development of new administrative policies; annual review of all departmental policies in conjunction with HMD Director and MPHC Medical Directors, as necessary. Works closely with the Director Health Management, medical director staff, and compliance and legal counsel on a variety of departmental functions and issues, as necessary.
Assists with care management activities in a back-up clinical capacity if needed.
Requirements
Bachelor's degree in healthcare field required with BSN preferred.
Master's in nursing or related field of study preferred.
5+ years of care management experience in a managed care setting including experience in a leadership role.
RN experience in a clinical setting required.
Licensed as an RN in Maine and other appropriate jurisdictions as necessary.
CCM required.
Skills and Competencies
Demonstrates an understanding of and alignment with Martin's Point Values.
Excellent interpersonal, verbal and written communication skills.
Critical thinking: can identify root causes and implement creative solutions; analyze and apply data to inform decision-making.
Ability to demonstrate a clear understanding of the standards of professional practice in decisions, leadership and documentation.
Ability to prioritize time and tasks efficiently and effectively for self and others.
Ability to prioritize and manage multiple competing demands.
Ability to function independently.
Computer proficiency in Microsoft Office products including Word, Excel, and Outlook.
Strong management and leadership skills.
Ability to demonstrate and support MPHC Core and Manager Competencies.
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