Manager of Care Management (44303)

This position oversees operational activities of the Care Management area of the Medical Management department. This includes program development and monitoring, staff development including overseeing frontline supervisors. He/she assists in developing and operationalizing new programs and insures regulatory and contractual requirements are met.

Duties and Responsibilities

• Develops, executes and evaluates work plan for area of responsibility
• Ensures ongoing monitoring, evaluation, and outcome measurement for all Case Management (CM) programs
• Provides regular reports and presentations on clinical outcomes of CM programs
• Identifies opportunities and cost/benefit for new CM programs and enhancements to existing programs, using data analysis tool
• Assists with developing case management programs for new lines of business
• Manages CM supervisory staff
• Provides supervision, direction and guidance to team while serving as the subject matter expert and lead on functional deliverables
• Provides performance feedback and coaching to staff, as well as makes hiring and termination decisions
• Assist in the training of new staff and providing an environment of continuous learning for existing staff
• Sets performance standards and productivity measures for direct reports
• Professional development of staff, including identification of educational opportunities, annual performance appraisals and goal development
• Determines/monitors staffing ratios
• Develops and ensures consistency in CM documentation standards
• Works with Clinical Trainers in the development of comprehensive role specific orientation/training programs
• Manages the development of CM policies and procedures and ensures annual review and revision
• Collaborates with Chief Medical Officer and Medical Director on new and existing clinical programs
• Serves as organizational consultant for CM performance practice
• Participates in administrative budget development and monitoring for area of responsibility
• Identifies and recommends opportunities for improvement and implements process improvement activities
• Representative of CM programs with state and community partners
• Collaborates with Matrix partners to develop, maintain and evaluate programs
• Other duties as assigned
• Corporate Compliance Responsibility - As an essential function, responsible for complying with Neighborhoods Corporate Compliance Program, Standards of Business Conduct, applicable contracts, laws, rules and regulations, policies, and procedures as it applies to individual job duties, the department, and the Company. This position must exercise due diligence to prevent, detect, and report unlawful and/or unethical conduct by fellow co-workers, professional affiliates and/or agents.

Qualifications

Required:

• Bachelor degree in health related field or in lieu of Bachelors degree; Associate degree in Nursing with seven (7) years or more in supervisory experience
• Active, unrestricted Rhode Island nursing license in good standing. (Consideration will be given to individuals without current RI license. Must provide documentation confirming RI RN application within 24 hours of offer)
• Five (5)+ years experience in field of clinical, managed care and/or operational management
• Five (5) years supervisory experience
• Strong collaboration, interpersonal and leadership skills
• Strong oral and written communication skills
• Strong analytical skills
• Proven ability to develop innovative programs and services
• Well-developed organizational and planning skills
• Ability to independently problem solve
• Intermediate to Advanced skills in Microsoft Office (Word, Excel, PowerPoint, Outlook)
• Ability to work extended hours including evenings, nights and weekends

Preferred:

• Certification as a Case Manager from an accredited Case Management program
• Knowledge of state agencies and community family support resources
• Bilingual

Neighborhood Health Plan of Rhode Island is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.