Manager of Care Management

Neighborhood Health Plan of Rhode Island; Smithfield (RI); On-site; USD 85,000 - 120,000; Full time

Job summary

Neighborhood Health Plan of Rhode Island is seeking a senior leader to oversee the Care Management area within Medical Management. You will guide program development, staff supervision, and the operationalization of new CM programs while ensuring regulatory and contractual requirements are met.

The role includes directing work plans, monitoring outcomes, and delivering regular clinical reports. You will lead continuous improvement, collaborate with medical leadership, and serve as a CM subject

Qualifications

• Active, unrestricted Rhode Island Nursing or LICSW license in good standing ( RI license application within 24 hours of offer).
• 5+ years’ experience in clinical, managed care and/or operational management.
• 5+ years supervisory experience.
• Strong collaboration, interpersonal and leadership skills.
• Proficient in Microsoft Office (Word, Excel, PowerPoint, Outlook).
• Ability to work extended hours including evenings, nights and weekends.

Responsibilities

• Develops, executes and evaluates work plans for area of responsibility.
• Monitors, evaluates, and reports on CM program outcomes.
• Supervises staff and provides coaching and performance feedback.
• Collaborates with Chief Medical Officer and Medical Director on CM programs.
• Develops and maintains CM documentation standards and policies.
• Participates in budget development and operational improvement initiatives.
• Represents CM programs with state and community partners.

Skills

Leadership

Analytical skills

Communication

Collaboration

MS Office

Education

Bachelor’s degree in health-related field

Associate degree in Nursing with 7+ years supervisory

Master’s degree (preferred)

Tools

Microsoft Office

Job description

This position oversees operational activities of the Care Management area of the Medical Management department. This includes program development and monitoring, staff development including overseeing frontline supervisors. This position assists in developing and operationalizing new programs and ensures regulatory and contractual requirements are met.

Duties And Responsibilities

• Develops, executes and evaluates work plan for area of responsibility
• Ensures ongoing monitoring, evaluation, and outcome measurement for all Case Management (CM) programs
• Provides regular reports and presentations on clinical outcomes of CM programs
• Identifies opportunities and cost/benefit for new CM programs and enhancements to existing programs, using data analysis tool
• Assists with developing case management programs for new lines of business
• Provides supervision, direction and guidance to team while serving as the subject matter expert and lead on functional deliverables
• Provides performance feedback and coaching to staff, as well as makes hiring and termination decisions
• Assist in the training of new staff and providing an environment of continuous learning for existing staff
• Sets performance standards and productivity measures for direct reports
• Professional development of staff, including identification of educational opportunities, annual performance appraisals and goal development
• Determines/monitors staffing ratios
• Develops and ensures consistency in CM documentation standards
• Works with Clinical Trainers in the development of comprehensive role specific orientation/training programs
• Manages the development of CM policies and procedures and ensures annual review and revision
• Collaborate with Chief Medical Officer and Medical Director on new and existing clinical programs
• Serves as organizational consultant for CM performance practice
• Participates in administrative budget development and monitoring for area of responsibility
• Identifies and recommends opportunities for improvement and implements process improvement activities
• Representative of CM programs with state and community partners
• Collaborate with Matrix partners to develop, maintain and evaluate programs
• Other duties as assigned

Qualifications

Required:

• Active, unrestricted Rhode Island Nursing OR Licensed Independent Clinical Social Worker (LICSW) license in good standing. (Consideration will be given to individuals without current RI license. Must provide documentation confirming RI RN or LICSW application within 24 hours of offer)
• Bachelor degree in health related field or in lieu of degree; Associate degree in Nursing with seven (7) years or more in supervisory role
• Five (5) + years’ experience in field of clinical, managed care and/or operational management
• Five (5) + years supervisory experience
• Strong collaboration, interpersonal and leadership skills
• Strong oral and written communication skills
• Strong analytical skills
• Proven ability to develop innovative programs and services
• Well-developed organizational and planning skills
• Ability to independently problem solve
• Intermediate to Advanced skills in Microsoft Office (Word, Excel, PowerPoint, Outlook)
• Ability to work extended hours including evenings, nights and weekends

Preferred:

• Masters degree
• Certification as a Case Manager from an accredited Case Management program
• Knowledge of state agencies and community family support resources
• Bilingual

Neighborhood Health Plan of Rhode Island is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.