Clinical Nurse for Care Management

The Clinical Nurse for Care Management 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 Medicare and Medicaid population and is an integral member of the Care Management Leadership team. The Clinical Supervisor of Care Manager supports the operations of the Care Management Department through monitoring the staff's adherence to quality and productivity standards; assisting with responding to patients’s needs; and providing clinical supervision and leadership for compliance and performance improvement.

Qualifications

Minimum Education

• Bachelor's Degree Nursing, Social Work, Health Services (Required)
• Master’s Degree in Nursing, Social Work, Health Services (Preferred)
  
  

Minimum Work Experience

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

Required Skills/Knowledge

• Understanding of Medicare/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

• Registered Nurse Licensed in New York State Upon Hire (Required)
• Certification in Case Management (Preferred)
  
  

Job Functions/Essential Duties

• Responsible for day-to-day operations of an assigned team
• Responsible for a team of 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 the Director of Care Management in establishing, implementing, and ensuring care management policies, practices, and procedures are in place
• In conjunction with the Director of Care Management, coordinates, develops and implements action plans 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 using 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 for completing all annual performance reviews for assigned staff
• Apply 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.
• Participate 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
• Clinical Supervisor of Care Management (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.
  
  

Other Job Duties

• May perform other duties in addition to those outlined in this job description
• Organizational Accountabilities
  
  

Leadership Excellence

• Demonstrates understanding of quality of service and collaborates with co-workers to ensure excellence is achieved
• Innovates through improvement of care and/or efficiency of operational processes.
• Dedicated to a standard of performance excellence and high quality
  
  

Collaboration

• Creates a safe environment that encourages brainstorming, creativity and “out-of-the-box” thinking
• Encourages a diverse group of people to communicate effectively and embrace creative thinking
• Drives the collaborative efforts of the team to achieve goals in the most effective and efficient way
• Demonstrates listening and feedback skills
  
  

Leadership Skills

• Proactively assumes responsibility and accountability for results to include management of organizational change
• Empowers staff in ensuring a culture of transparency, fairness, respect and excellence
• Strategically aligns operational and tactical objectives to drive business results
• Encourages collaboration with team members based on trust, mutual respect, consistent visible support, and open and honest communication
• Supervisory Responsibilities
• The incumbent will be responsible for the general direction of staff members(s).
  
  

Protected Health Information Access Level

• Full Access Incumbents in this job may access any protected health information associated to a customer's needs, the service(s) rendered and the position's functions.
  
  

Working Environment

• This job operates in an office environment.
  
  

Physical Requirements

Sedentary Work: Lifting 10 lbs. maximum and occasionally lifting and/or carrying such articles as dockets, ledgers and small tools. Although a sedentary job is defined as one that involves sitting, a certain amount of walking and standing is often necessary in carrying out job duties. Jobs are sedentary if walking and standing are required only occasionally, and other sedentary criteria are met.