Lead, Integrated Care Coordination — Ohio Waiver

CareSource; Ohio; Sur place; USD 72 000 - 116 000; Plein temps

Résumé du poste

CareSource in Ohio seeks a Team Lead for Integrated Care Coordination - Waiver who will supervise Care Coordinators and manage a reduced caseload of MyCare HCBS Waiver members. The role serves as the first escalation point for clinical and operational issues and helps ensure program goals, regulatory requirements, quality standards, and member outcomes.

Responsibilities include overseeing daily workflows, conducting case reviews, balancing workloads, providing coaching, and coordinating with

Qualifications

• Associates degree in healthcare required.
• Bachelor's degree in Nursing, Social Work, Healthcare Administration or related field preferred.
• Three (3) years of care management, care coordination, HCBS Waiver, LTSS, Medicaid, or managed care experience required.
• Prior leadership experience is preferred.

Responsabilités

• Provide day-to-day oversight and direction to assigned Care Coordinators.
• Monitor daily operational workflows and ensure timely completion of assessments, service plans, contacts, authorizations, and member outreach activities.
• Serve as the first level escalation point for staff questions, barriers, member concerns, and operational issues.
• Facilitate team huddles, case reviews, and workload discussions.
• Assist with caseload balancing and workload distribution.
• Provide consultation regarding HCBS Waiver requirements, service planning, person-centered planning, care coordination, and service delivery.
• Assist staff with complex member situations, transition planning, service gaps, provider issues, and member health and welfare concerns.
• Support implementation of care plans and service plans in accordance with MyCare HCBS Waiver requirements.
• Assist staff with identifying community resources and supports to address member needs.
• Support continuity of care activities during transitions between settings, providers, programs, and care coordinators.
• Conduct routine documentation audits and quality reviews.
• Monitor compliance with assessment, service planning, and outreach timeframes.
• Identify trends, risks, and compliance concerns and escalate to the Manager.
• Assist in preparation of corrective action activities and quality improvement initiatives.
• Monitor adherence to policies, procedures, workflows, regulatory requirements, and operational expectations.
• Coach, mentor, and develop assigned Care Coordinators, providing real-time feedback and performance coaching.
• Partner with the Manager regarding performance concerns, training opportunities, and professional development needs.
• Assist with onboarding and training of new staff and support annual competencies and ongoing staff education initiatives.
• Partner with providers, Community Partners, delegates, vendors, and internal departments to support member needs.
• Participate in interdisciplinary meetings, operational workgroups, and stakeholder meetings as assigned.
• Serve as a resource regarding HCBS Waiver program requirements and operational processes.
• Maintain a reduced caseload as assigned.
• Serve as the primary coordinator or consultant for High-risk members, Members with repeated incidents, Complex transition cases, Members requiring multidisciplinary intervention, Members experiencing service gaps or Members with significant social determinants of health challenges
• Perform any other job related duties as requested.

Connaissances

Care coordination

Leadership

Coaching

Communication

Microsoft Office

Formation

Associate degree in healthcare

Bachelor's degree in Nursing, Social Work, Healthcare Administration or related field

Outils

Microsoft Office

Description du poste

CareSource in Ohio seeks a Team Lead for Integrated Care Coordination - Waiver who will supervise Care Coordinators and manage a reduced caseload of MyCare HCBS Waiver members. The role serves as the first escalation point for clinical and operational issues and helps ensure program goals, regulatory requirements, quality standards, and member outcomes.

Responsibilities include overseeing daily workflows, conducting case reviews, balancing workloads, providing coaching, and coordinating with