Supervisor - Care Management

Supervisor, Care Management

Washington, D.C (In Office Requirement - Once every 90 days)

Description

The Supervisory Care Manager is responsible for the mentoring, training and clinical supervision of care management staff and oversight of staff caseloads of enrollees who have mild to complex medical and mental/behavioral health needs. This position has a broad knowledge base related to the needs of the Medicaid population and is an integral member of the Care Management Leadership team. The Supervisory Care Manager supports the operations of the Care Management Department through monitoring of staff's adherence to quality and productivity standards; assisting with responding to enrollee's needs; and providing clinical supervision and leadership for compliance and performance improvement.

Job Functions

Essential job duties:

• Responsible for day to day operations of an assigned team
• Responsible for a team of up to 12 licensed and unlicensed care management staff
• Reviews cases regularly with staff; acts as a clinical consultant regarding care management issues; guides clinical staff with review of assessments and care plans, evaluates utilization reviews and/or documentation
• Assists Associate Directors and Director in establishing, implementing, and ensuring care management policies, practices, and procedures are in place
• In conjunction with the Associate Directors and Director, coordinates, develops and implements action plan to respond to areas of need
• Leads and offers expert guidance and direct supervision to the team in aspects of care management: assessment, planning and implementation, coordination
• Assist the team with monitoring, and evaluation of options and services to meet the routine and complex health and behavioral health care needs of members
• Monitors work performed by team members according to organization, department and community standards
• Monitors productivity through the use of various reports to support appropriate outcomes and assign corrective action plans to staff as needed for immediate review and resolution
• Conducts regular team meetings in accordance with contractual agreement and as needed
• Responsible to complete all annual performance reviews for assigned staff
• Applies advanced problem-solving and analytical skills to evaluate and address complex situations involving members, providers, staff and community professionals
• Submits routine and special reports as assigned or requested.
• Participates in internal and external multidisciplinary team meetings.
• Attends/conducts meetings internally or externally with other government agencies or community organizations involved with enrollees in the health plan as needed
• Conducts weekly/bi-weekly supervision with assigned staff
• Responsible for oversight of assigned staff in maintaining caseload and contractual compliance metrics
• Supervisory Care Manager (Special Populations):
• The responsibilities of the Care Management staff assigned to these populations are inclusive of the duties outlined above with further detail in their respective program description and/or policy.
  
  

Qualifications

Minimum Education

Bachelor's Degree Nursing, Social Work, Health Services (Required)

Minimum Work Experience

Master's Degree Nursing, Social Work, Health Services (Preferred)

3 Years Progressive Supervisory Experience Preferred (Preferred)

3 years of related experience in managed care and /or care management preferred (Preferred)

Required Skills/Knowledge

Understanding of Medicaid benefits

Excellent verbal and written communication skills

Familiarity with computer systems and applications. Computer literate in Microsoft suite

Strong organizational skills

Ability to interpret and apply departmental requirements

Ability to make sound decisions and use good judgment

Must be able to work under pressure and meet deadlines, while maintaining a positive attitude and providing exemplary customer service

Ability to work independently and to carry out assignments to completion within parameters of instructions given, prescribed routines, and standard accepted practice

Required Licenses and Certifications

Ind. Clinical Social Worker Licensed in District of Columbia Upon Hire (Required) Or

Registered Nurse Licensed in District of Columbia Upon Hire (Required)

Certification In Case Management (Preferred)

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