Manager, Care Coordination

US-MI-Detroit
Req No.
2017-2097
Category
Operations
Type
Regular Full-Time

Overview

Concerto delivers comprehensive care to Medicare, Medicaid, and complex-needs patients. For over a decade, we have provided extraordinary outcomes for thousands of people in these underserved groups.

The Concerto name reflects our unique approach to healthcare. It’s about how we work in concert with patients, providers, and health plans. It’s about the harmony of a patient’s care, health, and dignity.

 

The Manager, Care Coordination, is responsible for the oversight, management and optimization of all care coordination activities as it relates to pre-admission, ambulatory case management, inpatient, social service, home health, health education, behavioral health and other health care delivery programs. Manages staff directly and is responsible for the day-to-day operations of the care management program.  

Responsibilities

  • Manage and mentor staff to meet departmental goals; includes Case Managers, Social Workers, and Navigators.
  • Manage schedules and resourcing to ensure proper coverage and staffing ratios to support the Care Coordination practice models
  • Ensure the appropriate administration of member benefits
  • Gather and analyze program data and implement action plans that result in measurable outcomes.
  • Manage and supports the on-going person-centered planning process.
  • Monitors risk assessments for completion by Case Managers within the required timeframe.
  • Confirms that the enrollee’s preferences and goals are honored.
  • Ensures that that Case Managers provides the enrollee with any necessary assistance and accommodations to prepare for and fully participate in the care planning process.
  • Conducts staff meetings, assuring policy and procedures are adhered to and when necessary, modified to address changing strategic objectives.
  • Responsible for orientation of new staff, on-going training, mentoring, and performance reviews.

Qualifications

  • Bachelor's degree (B.A. or B.S., BSN is preferred) from a four-year college or university plus valid/current applicable State RN license.
  • Case Management training, certification preferred.
  • Minimum of three (3) years clinical experience.
  • Four (4) years of experience in an HMO/IPA/Managed Care setting.
  • Strong leadership skills with experience as a Manager or Supervisor.
  • Innovation, flexibility, and adaptability are key attributes.
  • Knowledge of long-term care, community resources, and cost-effective alternatives regarding patient care delivery systems.
  • Knowledge of, clinical standards of care, NCQA requirements, CMS guidelines, and Medicaid/Medicare contracts and benefit systems is preferred.
  • Knowledge of CPT, ICD-9 and HCPCS codes
  • Basic computer skills in a Windows operating environment including Microsoft Word, Excel, and an e-mail system. 
  • Strong interpersonal and decision-making skills

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