Details
Posted: 16-Jun-22
Location: Poughkeepsie, Town of, New York
Type: Full Time
Salary: Open
Categories:
General Nursing
Internal Number: MANAG005378
* Sets team direction, resolves problems, and provides guidance to members of own team.
* Serve as a clinical resource and coach for Complex Case, Disease and Transitional Case Management programs
* Onboards all OCNY contracted providers and establishes effective care management workflows and sharing of information between case managers and providers
* Adapts departmental plans and priorities to address business and operational challenges.
* Influences or provides input to forecasting and planning activities.
* Answer clinical questions from staff and resolving client issues
* Provide ongoing training and education on clinical knowledge
* Handle escalated issues when necessary
* Provide updates and conducting meetings with clients as needed
* Maintain staff levels, interviewing, and hiring employees and enforcing disciplinary actions
* Conduct employee performance reviews
* Conduct call monitoring and case auditing of staff, and implementing performance improvement plans
* Ability to work in a fast-paced environment
* Independently serve as the clinical liaison with hospital, clinical and administrative staff within our documentation system for discharge planning and/or next site of care needs.
* Establish process for care team to make referrals to community sources and programs
* Facilitate complaint process by engaging member, family, and caregivers telephonically
* Establish a process for member education to assist with self-management goals, disease management or acute condition
* Utilize evidenced-based practice to develop interventions
* Establish a process to utilize motivational interviewing techniques to understand cause and effect, gather or review health history for clinical symptoms, and determine health literacy
* Manage quality of clinical assessments and Care Plans
* Oversee Interdisciplinary Care Team (IDCT) process
* Coordinate regular clinical reviews of high-risk cases with members of the Interdisciplinary Care Team (IDCT)
* Ensure adherence to relevant state and federal guidelines (e.g., Medicare, Medicaid, SNP, Commercial) and regulatory bodies (e.g., CMS, NCQA, URAC, InterQual) for Complex Case, Disease and Transitional case management.
* Demonstrate understanding of utilization management processes
* Maintain in-depth knowledge of all company products and services as well as customer issues and needs through ongoing training and self-directed research
* Monitor staff caseload in an efficient and effective to ensure optimal productivity
* Monitor and ensure timely and accurate documentation in the care management electronic software system to comply with documentation requirements and achieve individual and collective audit scores of 95% or better on a monthly basis
* Monitor staff licensure, certifications, and annual training are maintained and compliant
* Attends meetings and participates on committees as requested
* Identifies opportunities for process improvement in all aspects of member care
* Supports data collection and closing of care gaps and quality metrics as assigned, and assists the healthcare team in meeting quality metrics
* Must maintain strict confidentiality at all times
* Must adhere to all department/organizational policies and procedures
* May oversee work activities of other supervisors.
* Performs all other related duties as assigned
Required Qualifications:
To perform this job successfully, an individual must have the following education and/or experience.
* Current, unrestricted RN license required, specific to the state of employment
* Bachelor of Science in Nursing
* 3+ years of diverse clinical experience; preferred in managed care (delegated medical management), Complex Case Management, Disease Management and Transitional Case Management
* 1+ years of recent leadership experience (manager, supervisor, team lead, etc.), with ability to partner with staff to build high-performing teams.
* Expert knowledge of case management principles, as evidenced by certification in Case Management (CCM) or willing to obtain within 6 months of employment
* Knowledge of relevant state and federal guidelines (e.g., Medicare, Medicaid, SNP, Commercial) and regulatory bodies (e.g., CMS, NCQA, URAC, InterQual)
* People-management experience, to include motivational leadership, ability to implement performance improvement plans, and a drive to see employees succeed in their work
* Experience managing direct reports to performance metrics
* Proficient with Microsoft Office applications including Word, Excel, and PowerPoint
* Willing to occasionally travel as deemed necessary
Preferred Qualifications:
* 5+ years of managed care (delegated medical management), Complex Case Management, Disease Management and Transitional Case Management experience
* 3+ years of recent leadership experience (manager, supervisor, team lead, etc.), with ability to partner with staff to build high-performing teams.
* Knowledge of utilization management, quality improvement, and discharge planning
* Ability to cultivate a strong internal culture designed around collaboration, feedback, motivation, and accountability
* Solid communication and interpersonal skills
* Demonstrated ability to work in a fast pace, multi-tasking team environment while meeting deadlines
* Highly skilled in leading change efforts and in building strong partnerships with business-line executives
* Ability to summarize complex issues and problems into a concise report focused on key findings and outcomes
* Ability to consistently manage up and down
* Ability to complete initiatives with minimal supervision
* Proficiency in developing communication strategies for a wide array of audiences that support strategic objectives
* Demonstrated sophisticated written and verbal presentation abilities; experience with the development of presentation materials (collateral, proposals, presentations, talking points, etc.)
* Proven proficiency in the management of time, flexibility, and influencing colleagues to meet demanding project/requested timelines
Physical & Mental Requirements:
* Ability to lift up to 25 pounds
* Ability to sit for extended periods of time
* Ability to stand for extended periods of time
* Ability to use fine motor skills to operate office equipment and/or machinery
* Ability to receive and comprehend instructions verbally and/or in writing
* Ability to use logical reasoning for simple and complex problem solving
Full COVID-19 vaccination is an essential requirement of this role. CareMount will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination prior to employment to ensure compliance.
All qualified applicants will receive consideration for employment without regard to race, ethnicity, color, religion, sex, gender identity, sexual orientation, national origin, disability, or protected veteran status. CareMount is an EO employer - M/F/Veteran/Disability
