Manager, Care Management

US-MI-Kalamazoo
Req No.
2017-2164
Category
Operations
Type
Regular Full-Time

Overview

Concerto delivers comprehensive care to Medicare, Medicaid, and complex-needs patients. The Concerto name reflects our unique approach to healthcare. It’s about how we work in concert with patients, providers, and health plans. Our approach focuses on bringing harmony across the spectrum of a patient’s care, health, and dignity.

 

Summary:

The Manager, Care Management, is responsible for the oversight, management and optimization of patient centered care coordination activities. The manager oversees a team of care managers and is responsible for the day-to-day operations of the care management program.

Responsibilities

  • Manage, oversee and mentor staff (Care Managers and Patient Care Coordinators) in the performance of their job duties
  • Develop and/or update existing care management policies and procedures and implement monitoring activities to ensure adherence
  • Identify industry best practices for Care Management and recommend practice changes as needed
  • Hold staff to high standard of execution both clinically and operationally
  • Manage schedules and resourcing to ensure proper coverage and staffing
  • Ensure high quality, complete and accurate documentation for all activities
  • Implement processes to drive efficiency (working smarter not harder)
    • Manage staff productivity by developing and monitoring operational reports
    • Manage expense against a budget
  • Evaluate and escalate concerns that have potential patient impact
  • Ensure Care Managers have clear understanding of Concerto’s differentiated patient experience and that it is delivered to each and every patient in accordance to Concerto’s values
  • Train and educate on customer service standards for all care management facing customers (patients, caregivers, plan partners, regulatory agencies, etc.)
  • Orientation of new staff, on-going training (annual and other mandatory), mentoring, and performance reviews
  • Other duties as assigned

 

Qualifications

  • Minimum of 2 yrs in a clinical management role with direct reports
  • Minimum of 10 yrs experience in a clinical setting
  • Minimum bachelor's degree (B.A. or B.S., BSN is preferred) from a four-year college or university
  • Valid/current RN license in state of practice
  • Case Management training, certification preferred
  • Experience in an HMO/IPA/Managed Care setting preferred
  • 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
  • Ability to work in a Windows based computing environment
  • Strong interpersonal and critical-thinking skills
  • Proven track record of leading and building teams to drive measureable results
  • Self-directed and committed to continuous improvement of processes and procedures
  • Ability to work and collaborate cross-functionally
  • Ability to adapt to a fast paced, changing environment
  • Comfort embracing and navigating ambiguity

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