Managed Care Program Manager - One Care

AgeSpan

About Us: Since 1974 our agency has strived towards supporting an individual's desire to make their own decisions, secure their independence and remain living independently in the community. We are proud of our employees who make this possible every day. Our agency is a thought-leader, a nationally known generator of new ideas, because it welcomes creativity, your ideas. It is an outstanding place to work stimulating, friendly, collaborative. We offer competitive salaries, generous vacation time, and an excellent work/life balance. We value diversity and encourage career growth. If you have a passion for improving the lives of the elderly community and enjoy working in a diverse team driven by its mission, you've found the right place!

At AgeSpan, you'll find a work environment that combines:

• A refreshing culture that is supportive, collaborative, and encouraging of diverse perspectives and backgrounds.
• A focus on innovation with a team recognized for developing and implementing innovative programs and novel solutions.
• Encouragement of your development through opportunities to get involved, use your voice, and gain new knowledge and skills.
• A satisfying balance between your work and personal life, including a flexible workplace, generous paid time off, and wellness programs.

Depending on your role and your hours, we offer:

• Flexible schedule and hybrid work opportunities
• Competitive salaries
• Healthcare (medical, dental)
• 403b Retirement Plan with agency match
• 20 Vacation Days, 12 Sick Days, and 12 Paid Holidays
• Social Work Licensing Program
• License Renewal Paid by agency for RN's and Social Workers
• Mileage reimbursement
• Free parking
• Employee Referral Bonuses
• Employee Assistance Program
• Tuition Remission Program
• Agency subsidized gym membership (on-site in Lawrence)
• Commitment to promoting within

Position Responsibilities: The Managed Care Program Manager- One Care will work as a member of the Managed Care Leadership Team to ensure the smooth operation of the Managed Care Programs within the department. This Manager will participate in the training, quality assurance, and performance evaluations of the Managed Care direct staff and work with assigned Managed Care teams to ensure that all staff, new and experienced, receive adequate training and support to perform basic job functions.

Essential Functions: (Core duties or tasks that is fundamental and not marginal to the performance of the job)

Program Oversight:

• Onboard, train, and provide ongoing supervision and quality oversight related to the Long-Term Support Coordinator (LTSC) utilizing both the ASAP and One Care data bases
• Ensure that the unique One Care data entry requirements are completed in the timeframes required by each One Care plan
• Act as the Liaison between AgeSpan and each One Care plan to ensure that the LTSC completes contractual requirements, responds to all programmatic inquires and coordinates all requests from the One Care plans
• Participate in agency performance evaluations with each One Care plan and resolve practice issues identified
• Operationalize Managed Care Annual Operating Plan (AOP) and create annual goals for programs
• Comply with written policies and procedures related to the operation of each One Care program, conduct audits, run reports and other compilations of data pursuant to each One Care requirement
• Prepare for, track, and work toward timely and accurate admissions and discharges to each One Care program
• Supervision of administrative staff including but not limited to Managed Care Case Aides
• Collaborate with Director of Managed Care and Fiscal Department regarding billing process for all programs and rectify claims/ billing issues as they arise. Oversee service authorization processes
• Implement departmental quality assurance and development of quality improvement initiatives including report running, conducting audits, data analysis for trends, improvements and efficiencies, etc.
• Complete annual performance review and programmatic as needed
• Implement IT initiatives and projects pertaining to the Managed Care Department
• Ensure accurate and timely documentation across all One Care and AgeSpan systems
• Act as the Liaison between AgeSpan departments and One Care to ensure cooperation and timely exchange of information regarding enrollees known to both
• Attend local and statewide meetings with One Care for training, system updates and collaboration
• Other duties as assigned

Management of Managed Care Team - Provisional Employees:

• Coordinate and participate in the new staff orientation processes for One Care
• Provide weekly one-on-one supervision to review all case documentation for accuracy and compliance with One Care and AgeSpan standards and to discuss clinical issues
• Track home visits and monitor progress of new referrals through case review and software tracking methods to ensure compliance and provide training on managing the pace of the work
• Maintain open communication with the Team Lead of employees on Provisional Employment status to gather feedback on the new employee's progress and discuss timelines for the new employee to assume additional team responsibilities.
• Work in coordination with Team Lead to complete the new employee's six-month Progress Report and make recommendations to the Director of Managed Care regarding regular employment status and termination of coaching period

Management of Managed Care Team - Experienced Direct Service Staff:

• Provide scheduled one-on-one supervision to review compliance with One Care and AgeSpan standards, provide support, and to discuss clinical issues
• Use tools to review monthly QA compliance including authorizations, billing, assessments, documentation
• Complete annual performance evaluations of One Care staff including compile annual QA data, summarizing Team Feedback, completing Manager's Summary, setting goals, assessing for merit increases and conducting evaluation meeting with employee
• Meet with experienced employees for remedial coaching and training relative to areas identified through agency Quality Assurance efforts as required
• Participate in Progressive Discipline process as indicated
• Promote professional development

Miscellaneous:

• Participate in rotation of Manager of the Day departmental coverage responsibilities
• Participate in agency middle management meetings and collaborate with other middle managers across departments
• Manage and implement caseload coverage plan and redistribution as needed within One Care program
• Participate in monthly clinical meetings, care plan team meetings, program clinical staff meetings, and other requested meetings by the One Care plans
• Serve as Team Manager for assigned teams including attending team meetings bi-weekly at minimum and work with teams around conflicts, coverage, and other issues that arise
• May assist in programs or special projects related to coaching, training, quality and customer service as required.

Qualifications: BA/BS or Associate's in Social Work, human services, or related field as well as significant related experience required. Experience in agency direct service (i.e., comprehensive knowledge of MassHealth/ASAP/Managed Care systems and programs) strongly preferred. Management experience preferred. Knowledge and experience in the following areas is strongly preferred: Quality Assurance and Quality Improvement systems and processes; data collection, reporting, and analysis, efficient in consumer databases, supervision, and training. Excellent organizational and time management skills; strong detail orientation; excellent leadership, written and verbal communication and presentation skills are also preferred.

Hours: 37.5 hours per week

Our Commitment to Diversity and Inclusion

AgeSpan is strongly committed to fostering a professional environment that recognizes, respects, and encourages the unique contributions of a broad spectrum of qualified employees. It is important that our employees reflect the diverse communities we serve. We maintain a work atmosphere that allows people of varied backgrounds to grow professionally and contribute to our mission by promoting diversity, equity, inclusion, and work-life balance.