Lead Case Manager - Specialty Team

Capital District Physicians Health Plan Inc; City of Albany (NY); On-site; USD 72,000 - 129,000; Full time

Benefits offered by this job

Remote work option

Job summary

Capital District Physicians' Health Plan Inc is seeking a Supervising Case Management & Clinical Operations Leader to oversee daily work of CM staff, coordinate department projects, staffing, and ensure high quality service while representing CM at internal and external meetings.

You will lead a dynamic team of Dietitians and Respiratory Therapists while driving innovation that enhances care delivery and operational excellence.

Qualifications

• Current New York State clinical licensure (RN, Licensed Behavioral Health Clinician, PT, NP, PA, or Dietitian) with a minimum of three years of case management/quality improvement experience or equivalent required.
• Knowledge of NCQA and/or Medicare and Medicaid guidelines preferred.
• Ability to multitask and balance priorities.
• Must demonstrate proficient experience in use of a computer. Example-creating documents, Word, Excel, Internet and email.
• Must possess strong leadership skills, excellent written and verbal communication skills, problem solving and analytical skills and the ability to deal effectively with all levels of personnel in the health care industry.
• For incumbents aligned to the Federal Employee Program (FEP) line of business, Case Management Certification required within two (2) years of either hire and/or moving into this role supporting the FEP LOB.

Responsibilities

• Provides direction and supervision to the CM staff including departmental function, individual development plans, performance reviews, and disciplinary actions.
• Responsible for coordinating communications and daily activities of the staff and assuring adequate staffing to accomplish Health Plan goals.
• Participates in recruitment, training, and retention of staff.
• Conducts periodic case reviews, employee performance reviews, and staffing patterns, identifying areas needing improvement and initiates appropriate action including productivity monitoring and inter-rater reliability.
• Holds staff accountable for meeting performance metrics and implements performance management process as necessary.
• May maintain individual case load, handles a subset of member clinical management programs (including physical health and behavioral health conditions).
• Coordinates regular team meetings with staff.
• Maintains employee files with updated annual performance reviews, professional and mandatory education, and annual statements with signature.
• Assists in the development of policies and procedures related to CM.
• Assists in implementing and monitoring departmental changes and initiatives necessary to accomplish Health Plan goals.
• Applies project management skills by developing and implementing new initiatives.
• Provides presentations as related to specific functions of area supervised.
• Is an effective liaison with other departments, members, providers, and community agencies.
• Identifies strategies to improve health care resource management and communicates to internal and external customers.
• Instructs and acts as a resource for staff in dealing with special situations or problems.Maintains documentation relative to the activities of the department and prepares reports as necessary, including those related to Quality Improvement activities. Keeps designated management aware of progress toward goals and productivity.
• Ensures staff compliance with all regulatory and accreditation standards. Keeps abreast of changes and responsible for implementation and monitoring of requirements.
• Accepts responsibility for personal professional education requirements per departmental policy.
• Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies' mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs.
• Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.
• Maintains knowledge of all relevant legislative and regulatory mandates and ensures that all activities are compliant with these requirements.
• Conducts periodic staff meetings to include timely distribution and education related to departmental and Ethics/Compliance information.
• Performs other duties and functions as assigned by management.

Skills

Leadership

Case management

Staff supervision

Communication skills

Project management

Regulatory compliance

Education

New York State clinical licensure

Tools

Word

Excel

Internet

Email

Job description

Capital District Physicians' Health Plan Inc is seeking a Supervising Case Management & Clinical Operations Leader to oversee daily work of CM staff, coordinate department projects, staffing, and ensure high quality service while representing CM at internal and external meetings.

You will lead a dynamic team of Dietitians and Respiratory Therapists while driving innovation that enhances care delivery and operational excellence.