Managed Care Program Manager - PCA

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
• And MORE!

Position Responsibilities: The Managed Care Program Manager- PCA will work as a member of the Managed Care Leadership Team to support staff within the PCA and Managed Care programs to ensure the smooth operation of the programs. This Manager will participate in the onboarding, training, quality assurance, data reporting and performance evaluation systems within the PCA and Managed Care programs. This Manager work with PCA direct service staff, new and experienced, to receive adequate training and support to perform basic job functions in a competent and professional manner. This position will also act as a Liaison between AgeSpan and MassHealth (EOHHS) in various capacities.

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

Program Oversight:

• Work collaboratively with other Managed Care Program Manager- PCA and Nurse Manager to ensure PCA regulations are being met
• Act as a Liaison between AgeSpan and MassHealth (EOHHS) to ensure that the agency complies with all terms of the EOHHS PCA requirements, oversee all contract related activities, respond to all inquiries and coordinate requests from EOHHS. Cooperate in EOHHS fraud detection, meet with other state agency representatives, and participate in any EOHHS meeting
• Participate in the agency performance evaluation with EOHHS and resolve any issues identified
• Be the responsible point person and lead for working with the Senior Care Organizations (SCO) and Integrated Care Organizations (One Care) on PCA referrals, processes, communication, system changes, and any issues relating to the SCO/PCA and One Care/PCA process
• Operationalize written policies and procedures related to the operations of the PCA program, conduct audits, reporting as requested and other compilations of data pursuant to the PCA contracts
• Collaborate with Director of Managed Care Programs and Fiscal Department regarding billing process for all programs and rectify claims/ billing issues as they arise
• Be a point person for PCA software, PCA Partner, including understanding data elements and function of database and training for staff
• Supervision of administrative staff including case aides and admin
• Other additional duties as assigned in relation to the Managed Care Department

Management of PCA Team- Provisional Employees:

• Coordinate and participate in the new staff onboarding and orientation processes for PCA programs
• Provide weekly one-on-one supervision to review all case documentation for accuracy and compliance with EOAI, MassHealth, and AgeSpan standards and to discuss clinical issues
• Track home visits and monitor progress of new referrals through case review, A&D and PCA software reports and other 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 in PCA and/or Managed Care and coordinate the 6-month progress report including recommendations to the Director of Managed Care Programs- PCA/One Care regarding regular employment status and termination of coaching period
• Work collaboratively with the Nurse Manager to ensure all hiring, training and oversight of RN's are in accordance with EOEA and PCA regulations

Management of PCA Team -Experienced Direct Service Staff:

• Provide scheduled one-on-one supervision to review compliance with PCA and ESMV standards, provide support, and to discuss clinical issues
• Maintain existing Quality Assurance systems in PCA and Managed Care Programs including case file auditing for Annual Performance Reviews and programmatic audits as needed
• Complete annual performance evaluations of Direct Service staff including conducting case audits, compiling 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 supervision, 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
• Attend team meetings monthly at minimum and work with Team Lead to manage team conflicts, coverage and other issues that arise
• Manage and implement caseload coverage plan and redistribution as needed within PCA program
• Participates in coverage of the Managed Care Department with the other Managed Care Program Managers.
• May assist in the management of programs or special projects related to coaching, training, quality, and customer service as required and assigned.

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.