Lead Care Manager

Network Health; Menasha, Midway Place (WI, LA); Remote; USD 55,000 - 85,000; Full time

Job summary

Ein etabliertes Unternehmen sucht einen Lead Care Manager, um das Team bei der Verbesserung der Patientenversorgung zu unterstützen. In dieser Schlüsselrolle arbeiten Sie eng mit Mitarbeitern und Führungskräften zusammen, um sicherzustellen, dass die Standards des Fallmanagements eingehalten werden. Sie sind verantwortlich für die Entwicklung von Richtlinien, die Durchführung von Fallprüfungen und die Unterstützung von Mitgliedern bei der Selbstverwaltung ihrer Gesundheitsbedürfnisse. Diese Position bietet die Möglichkeit, in einem dynamischen Umfeld zu arbeiten, in dem Ihre Beiträge einen direkten Einfluss auf die Patientenversorgung haben werden. Wenn Sie eine Leidenschaft für die Gesundheitsversorgung haben und in einem unterstützenden Team arbeiten möchten, ist dies die perfekte Gelegenheit für Sie.

Qualifications

• Mindestens 4 Jahre klinische Erfahrung als RN oder Sozialarbeiter.
• Aktuelle Lizenz als Registered Nurse oder Sozialarbeiter in Wisconsin erforderlich.

Responsibilities

• Entwicklung und Implementierung von Richtlinien für das Fallmanagement.
• Überwachung der Fallmanagement-Metriken zur Messung der Effektivität.

Skills

Kommunikationsfähigkeiten

Kritisches Denken

Organisationsfähigkeiten

Anpassungsfähigkeit

Teamarbeit

Education

Bachelor of Science in Nursing

Master's Degree in Social Work

Tools

Population Health Dokumentationsplattform

Job description

The Lead Care Manager works closely with front line department employees and leadership to be the first-line contact person for Care Management program inquiries. The Lead Care Manager acts as a subject matter expert for the Population Health documentation platform, performs routine case audits and Care Manager duties. In addition, the incumbent will assist with process improvement and policy/procedure maintenance.

Job Responsibilities:

1. Demonstrates commitment and behavior aligned with the philosophy, mission, values and vision of Network Health.
2. Appropriately applies all organizational, regulatory, and credentialing principles, procedures, requirements, regulations, and policies.
3. Assists in the development and implementation of policies, procedures, processes, materials, clinical guidelines, and documents for the care management program that comply with CMS, State of Wisconsin, NCQA, and other regulatory agencies. Assists the manager of care management in ensuring that standards are communicated to, and understood, by team members. Identifies gaps and works with department leadership to facilitate implementation of improved processes.
4. Serves as the first-line contact to facilitate resolution of clinical care management issues.
5. Acts as a subject matter expert for the Population Health documentation platform.
6. Performs monthly and quarterly case audits.
7. Assists in monitoring care management metrics that measure effectiveness and value of the case management programs.
8. Maintains a member caseload and performs core care manager roles, including screening candidates for case management, completing assessments, developing care plans with prioritized goals, interventions, and timeframes for reassessment using evidence-based clinical guidelines. Evaluates and determines member needs based on clinical or behavioral information; updates care plans to reflect progress; closes cases when goals are achieved; and provides information regarding activities to members, caregivers, providers, and staff. Also, evaluates and processes referrals, and advocates for members to identify interventions and resources to meet health needs, working with members and families on self-management and education.
9. Maintains current knowledge of State of Wisconsin, CMS & NCQA case management standards.
10. Stays informed of current best practices and new developments.
11. Performs other duties as assigned.

Job Skills:

• Strong oral and written communication skills, with the ability to listen mindfully, identify gaps, and ask appropriate questions.
• Strong critical thinking skills.
• Ability to organize work and space to ensure successful completion of tasks within deadlines.
• Ability to adapt to new circumstances, information, and challenges in a fast-paced environment.
• Ability to work independently and as part of a team in a remote setting.

Job Requirements:

• Bachelor of Science Degree in Nursing or Social Work required.
• Master's degree in Social Work preferred.
• Minimum of four (4) years of clinical healthcare experience as an RN or Social Worker.
• Minimum of two (2) years experience with Medicare, Medicaid, commercial fully insured, and/or self-funded populations.
• Experience with Network Health's processes is preferred.
• Current licensure as a Registered Nurse or Social Worker in Wisconsin is required.

Additional Notes:

Candidates must reside in Wisconsin. This role is eligible for remote work with reliable internet required.

We are proud to be an Equal Opportunity Employer that values diversity and inclusion. Applicants are encouraged to review their rights under federal employment laws, available at Know Your Rights.