Manager, CM

HRMCMI1201; Maryland; Hybrid; USD 100,000 - 140,000; Full time

Job summary

Maryland Care Management, Inc. (MCMI) in Maryland is seeking a Manager of Care Management to oversee CM programs and ensure compliant, high-quality care coordination for high-risk members.

The role involves staff recruitment, performance management, budget collaboration, and cross-functional teamwork with health plan stakeholders to improve outcomes and engagement.

Qualifications

• RN license required by state.
• BSN preferred but not required.
• Minimum two years of management/supervisory experience.
• Minimum three years of care management experience.
• CCM certification preferred.
• Managed Care experience preferred.

Responsibilities

• Oversee care management programs.
• Recruit and select staff; prepare for timely evaluations.
• Foster individual and team development; provide performance management.
• Prepare reports on key indicators for committees and leadership.
• Collaborate on annual CM budget and operate within approved budget.
• Work with interdisciplinary teams to coordinate care activities.
• Serve as CM resource for health plan information and integration.
• Assist in setting measurable CM goals using outcomes, quality indicators, regulations.
• Implement ongoing CM staff development and education.
• Ensure program integrity and regulatory compliance with CM Director.
• Perform other duties as assigned.

Skills

Presentation skills

Health care delivery knowledge

Problem solving

MS Office proficiency

Education

RN license (state)

BSN preferred

CCM certification preferred

Managed Care experience preferred

Tools

Microsoft Office

Job description

Summary/Position Objectives:

This position is responsible for oversight of the planning, development, implementation, and evaluation of Care Management (CM) programs. The Manager of CM is responsible for ensuring staff follow the care management process as defined by improving coordination, continuity, accessibility, and appropriate utilization of healthcare services and community resources for high-risk and special needs members, improving health outcomes and engagement in health seeking behaviors.

About Maryland Care Management, Inc. (MCMI)

Maryland Care Management, Inc. (MCMI) manages Maryland Physician Care's (MPC) statewide provider network of hospitals and physicians. Maryland Physicians Care has been providing services to the HealthChoice Medicaid populations since 1996, and we are proud of our footprint in the community. With over 230,000 members, MPC consistently has been one of MD's largest Medicaid-managed care organizations.

Why join us?

MCMI recognizes the importance of flexibility and offers multiple work arrangements. Along with competitive pay, we offer excellent benefits (medical, dental, and vision plans, 100% employer Term Life Insurance, Short and Long-Term Disability, 401k Employer Match up to 4%) as well as 20 days of PTO, and tuition assistance/professional development plans.Your future colleagues at MCMI are welcoming, friendly, and eager to help each other succeed. We are committed to Diversity, Equity, and Inclusion, providing organizational-wide social opportunities, and constantly improving our ongoing efforts to positively impact our members' lives.

What You'll Do:

• Provide oversight of care management programs.
• Responsible for recruitment and selection of appropriate staff and prepares for timely employee performance evaluations.
• Promote individual and team development and provide performance management, when necessary.
• Prepare reports on key indicators and activities for committees and senior management.
• Collaborate with the Director of CM on development of annual budget and operates within approved budget.
• Collaborate with interdisciplinary teams to support staff in coordination of care activities.
• Serves as a resource for health plan information and helps to integrate care management functions throughout the health plan.
• Assists in the annual development of measurable goals for care management programs based on data from outcomes reports, quality indicators, regulatory agencies, and health plan initiatives and priorities.
• Implement ongoing development and education of care management staff.
• Ensures that program integrity and regulatory requirements are met in conjunction with the Director of CM.
• Other duties as assigned.

Secondary Functions:

• Communicates regularly with employees through staff meetings to share company, health plan, and department information appropriate to their job function.
• Maintains and promotes patient confidentiality and adheres to HIPAA regulations.
• Responsible for development, implementation, and annual review of care management policies and desktops.

Requirements

Knowledge and Skills:

• Demonstrated skills for presentations and training before small and large groups.
• Knowledge of local health care delivery system.
• Strong problem solving, organizational, and time management skills with the ability to work in a fast-paced environment.
• The ability to successfully utilize Microsoft Office suite and common computer and office hardware is necessary.

Education and Work Experience:

• Current state RN licenserequired.
• Bachelor of Science in Nursing (BSN)preferred.
• Minimum of two years of management/supervisory experiencerequired.
• Minimum of three years of care management experiencerequired.
• CCM Certificationpreferred.
• Managed Care experience ispreferred.