Manager Case Management Long-term Care - Delaware

at Highmark Health in

Dover, Delaware, United States Job Description Company :

Highmark Inc.

Job Description :

JOB SUMMARY

This job supervises a team of Case Manager Supervisors who are charged with promoting quality member outcomes, optimizing member benefits, and promoting 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, compliance and quality outcomes. Hires, trains, coaches, counsels, and evaluates performance of direct reports. The incumbent 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

+ Perform management responsibilities to include, but are not limited to: involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity. Plan, organize, staff, direct and control the day-to-day operations of the department; develop and implement policies and programs as necessary; may have budgetary responsibility and authority. + 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 the 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, coordinate training and performance metrics/statistics to the team in addition to initiating and implementing process improvements. Assist with direct reports to problem solve escalated issues and identify and escalate issues appropriately. + Organize and facilitate staff meetings that assure corporate and operational communication supported by meeting minutes; and providing an open forum for issues and problem solving. + Suggest new approaches to complex problems. + Set appropriate targets, measure outcomes and establish plans to negate variances in quality, staff retention, finance and customer satisfaction. + Ensure all staff achieve the minimal qualifications, of their position, through ongoing staff development, counseling, individual and group education. + Manage and coordinate all department activities, staff education, policy and procedure development and revision, and individual staff audits. + Oversee overall operations to ensure compliance to standards. + Recruit, select, orient, evaluate, counsel, and develop performance improvement plans for all direct reports. + Promote and terminate per corporate policy, encourage career development and support of staff. + Develop and implement appropriate audit requirements in order to ensure compliance of 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, in order to enhance a shared 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. + Other duties as assigned/requested.

EDUCATION

Required + Bachelor's degree in Health Administration, Public Health or related field Substitutions + 6 years of progressive relevant experience in lieu of Bachelor's degree Preferred + Master's degree in a related human services field.

EXPERIENCE + 5

years of a clinical setting + 3 years in a case management/managed care role + 3 years in a management or leadership role Preferred + 1 year in a home clinical or case management role + Medicare or Medicaid experience LICENSES or

CERTIFICATIONS

Required + Current, valid, unrestricted license in one or more of the following disciplines:

LCSW , LSW , LPC

, or other related clinical license (OR) Current State RN licensure OR Current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC). Preferred + CCM - Certified Case Manager Certification 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 Language (Other than English):

None Travel Requirement:

0% - 25%

PHYSICAL , MENTAL

DEMANDS and

WORKING CONDITIONS

Position Type Office-based Teaches / trains others regularly Occasionally Travel regularly from the office to various work sites or from site-to-site Rarely Works primarily out-of-the office selling products/services (sales employees) Never Physical work site required

Yes Lifting:

up to 10 pounds

Constantly Lifting:

10 to 25 pounds

Occasionally Lifting:

25 to 50 pounds

Rarely Disclaimer:

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