Manager, Care Management (Molina DSNP)

US-WA-Renton
Req No.
2017-2216
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.

 

Summary:

 

The Manager, Care Management, 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; may include Care Managers, Social Workers, and Patient Care Coordinators.
  • Manage schedules and resourcing to ensure proper coverage and staffing ratios to support the Care Coordination practice models
  • Subject matter expert in program requirements and Model of Care contracts
  • Provides guidance to staff for interpretation of program requirements and works collaboratively with Director to develop business support tools for front-line staff
  • 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 Care Managers within the required timeframe.
  • Confirms that the enrollee’s preferences and goals are honored through auditing efforts.
  • Ensures that that Care 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.
  • Acts as a change agent for implementation of modifications to the program and daily requirements

Qualifications

  • 1-3 years of previous leadership experience preferred.       Health Plan leadership experience preferred.
  • Education/Experience: RN required. Advanced degree preferred or actively pursuing minimum of Bachelor's degree (B.A. or B.S.N.)from a four-year college or university plus valid/current applicable State RN license.
  • Care 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.  Includes proficiency in typing speed at least 40 WMP or greater.
  • Strong interpersonal and decision-making skills

 

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