Manager, Case Management RN- Integrated Care

CareSource; Mobile (AL); On-site; USD 75,000 - 120,000; Full time

Job summary

CareSource is seeking a Manager, Case Management - Integrated Care to oversee the Integrated Care Duals Product Teams and coordinate care, services, and health benefits for selected member populations.

The role ensures compliant utilization, manages care management teams, maintains care plans, and collaborates with stakeholders to optimize member outcomes. Requires RN/LISW/LPCC licensure options and relevant Medicaid/Medicare experience.

Qualifications

• Bachelor's Degree or equivalent years of relevant work experience required.
• Minimum of five (5) years of clinical experience.
• Three (3) years Medicaid/Medicare managed care experience preferred.
• Two (2) years of management experience preferred.

Responsibilities

• Oversee Integrated Care Duals Product Teams and coordinate care, services and benefits.
• Monitor utilization and ensure compliance with state and accreditation requirements.
• Manage performance of Care Management teams and ensure safe service delivery.
• Maintain member care plans and measure outcomes with stakeholders and providers.
• Lead day-to-day Care Center operations, staff training and policy adherence.

Skills

Leadership

Clinical experience

Communication

Regulatory knowledge

Project management

Education

Bachelor's Degree in Nursing, healthcare field, business administration or related field

Tools

Microsoft Outlook

Excel

Word

Mobile devices usage

Job description

Job Summary

The Manager, Case Management - Integrated Care is responsible for overseeing the Integrated Care Duals Product Teams in coordinating the care, service and health benefits for selected member populations.

Essential Functions

Monitors and promotes safe and effective utilization of healthcare resources through clinical variance and benefits management Actively manages the performance of the Integrated Care Management Liaisons and internal/external Care Management teams to ensure safe and effective service delivery, quality outcomes, and compliance with all state and accreditation requirements Assist in verifying eligibility, previous enrollment history, demographics and current health status of each member as appropriate Audit and review documentation gathered by internal staff and external partners to ensure thoroughness, accuracy and care management competency Contribute to the ongoing review of Member care plans, defining specific issues, goals and interventions as appropriate Responsible for ensuring that member/CM caseload ratios are kept at optimal levels Ensures that CM teams monitor and evaluate care plan effectiveness on an ongoing basis through member, family, provider, and stakeholder contact May assist Member liaisons in the facilitation and coordination of services based upon the care treatment plan developed in collaboration with all stakeholders Working with peer Managers and Director, responsible for overall day-to-day Care Center operations, team coordination, and member outcomes, including, new staff orientation and scheduling, training, in-servicing, quality and performance improvement, regulatory and contractual compliance Oversees effective care planning and implementation meeting member needs Oversees the coordination of services with community partners to maximize utilization of appropriate community resources and supports, and assure effective and appropriate transitions between settings of care Works with Incident Management staff in the review and investigation of member incidents and/or issues related to member health and safety Works with Community Partners, Provider Relations and Network Management staff in the ongoing monitoring of quality issues for network providers Monitoring of scheduling/work allocation and productivity Provides quality monitoring and conducts regularly scheduled one-on-one meetings with all team members Works with corporate staff in the follow up and review of member complaints and grievances Monitor and analyze Integrated Care Management data and reporting Assures overall compliance with the Integrated Care product model of care Oversee and/or maintain current and accurate documentation of contacts, care treatment plans, case notes, referrals, and assessments in Care Management electronic record and within protocols and guidelines of the Care Management program Actively oversee the performance of the Integrated Care Management teams to ensure all state and accreditation requirements are achieved Review and update all Care Management policies and Standard Operating Procedures May participate in meetings with providers to inform them of Care Management services and benefits available to members Serve as interdepartmental liaison and network with other departments to gather/share information about issues related to the Care Management process May assist in education of member/caregiver regarding healthcare access and benefits, and provide member/caregiver with health education and wellness materials Precept and/or mentor new staff Provide ongoing training, mentoring, coaching and disciplinary action as needed Participate in the hiring process of new Integrated Care Management personnel Provide guidance/instruction for Integrated Care Team Leads and other staff via formal and informal meetings Regular travel to conduct member visits, provider visits and community based visits as needed to ensure effective administration of the program Perform any other job duties as requested.

Education and Experience

Bachelor's Degree in Nursing, healthcare field, business administration or related field or equivalent years of relevant work experience required Minimum of five (5) years or more of clinical experience is required Minimum of three (3) years Medicaid and/or Medicare managed care or HCSB Waiver case management experience is preferred Three (3) years as a case manager is preferred Two (2) years of management experience is preferred.

Competencies, Knowledge and Skills

Intermediate proficiency level of Microsoft Outlook, Word and Excel Ability to operate smart phone, iPad, or other mobile communication devices to ensure productivity and ability to perform essential functions Ability to communicate effectively with a very diverse group of individuals Ability to multi-task and work independently within a team environment Ability to collaborate with and effectively lead other team members to optimize outcomes for members Familiarity of the state and federal healthcare regulations and environment Awareness of community and state support resources for population served Critical listening and thinking skills Decision making and problem solving skills Proper grammar usage Strong organizational and time management skills Proper phone etiquette Customer service oriented Training/teaching skills Management and prior supervisory skills.

Licensure and Certification

Current, unrestricted license in the state of Ohio as a Registered Nurse (RN), Licensed Independent Social Worker (LISW), Psychologist, or Licensed Professional Clinical Counselor (LPCC) Case Management certification is preferred Employment in this position is conditional pending successful clearance of a driver's license record check. If the driver's license record results are unacceptable, the offer will be withdrawn or, if you have started employment in this position, your employment in this position will be terminated To help protect our employees, members, and the communities we serve from acquiring communicable diseases, Influenza vaccination is a requirement of this position. CareSource requires annual proof of Influenza vaccination for designated positions during Influenza season (October 1 – March 31) as a condition of continued employment. Employees hired during Influenza season will have thirty (30) days from their hire date to complete the required vaccination and have record of immunization verified. CareSource adheres to all federal, state, and local regulations. CareSource provides reasonable accommodations to qualified individuals with disabilities or medical conditions, sincerely held religious beliefs, or as required by state law to enable the employee to perform the essential functions of the position. Request for accommodations will be completed through an interactive review process.

Working Conditions

Mobile Worker: This is a mobile position, meaning that regular travel to different work locations is essential. Will be exposed to weather conditions typical of the location and may be required to stand and/or sit for long periods of time Reside in the same territory they are assigned to work in; exceptions may be considered, due to business need May be required to travel greater than 50% of time to perform work duties. A valid driver's license, car, and insurance are necessary for work related travel Required to use general office equipment, such as a telephone, photocopier, fax machine, and personal computer Flexible hours, including possible evenings and/or weekends as needed to serve the needs of our member and may refer members to other CareSource resources.

Compensation

Compensation Range: $74,700.00 - $119,520.00 CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package. Compensation Type (hourly/salary): Salary Organization Level Competencies Fostering a Collaborative Workplace Culture Cultivate Partnerships Develop Self and Others Drive Execution Influence Others Pursue Personal Excellence Understand the Business.

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time.

Equal Opportunity Statement

CareSource is an Equal Opportunity Employer.

We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.

Additional Information

#LI-JS1 Brand=CareSource The CareSource mission is known as our heartbeat. Just as we support our members to be the best version of themselves, our employees are driven by our mission to create a better world for members, stakeholders and providers. We are difference-makers who combine compassionate hearts with our unique business expertise to make every opportunity count. Each claim, each phone call, each consumer‑centric decision is a chance to change the world for one member, and our employees look for ways to do that every day. The challenge is, there is no one right way to be the difference and we’re looking for people like you that will rewrite that definition every day. We do what it takes to form creative solutions that make our community and the world just a little better. Discover what it means to be #UniquelyCareSource.