Manager, Care Management

 •  Concerto Healthcare Kalamazoo, MI

11 - 15 years experience  •  IT Consulting/Services

Salary depends on experience
Posted on 07/18/17
Kalamazoo, MI
11 - 15 years experience
IT Consulting/Services
Salary depends on experience
Posted on 07/18/17

Summary:

The Manager, Care Management, is responsible for the oversight, management and optimization of patient centered care coordination activities. The manager oversees a team of care managers and is responsible for the day-to-day operations of the care management program.

Responsibilities:

  • Manage, oversee and mentor staff (Care Managers and Patient Care Coordinators) in the performance of their job duties
  • Develop and/or update existing care management policies and procedures and implement monitoring activities to ensure adherence
  • Identify industry best practices for Care Management and recommend practice changes as needed
  • Hold staff to high standard of execution both clinically and operationally
  • Manage schedules and resourcing to ensure proper coverage and staffing
  • Ensure high quality, complete and accurate documentation for all activities
  • Implement processes to drive efficiency (working smarter not harder)
    • Manage staff productivity by developing and monitoring operational reports
    • Manage expense against a budget
  • Evaluate and escalate concerns that have potential patient impact
  • Ensure Care Managers have clear understanding of Concerto’s differentiated patient experience and that it is delivered to each and every patient in accordance to Concerto’s values
  • Train and educate on customer service standards for all care management facing customers (patients, caregivers, plan partners, regulatory agencies, etc.)
  • Orientation of new staff, on-going training (annual and other mandatory), mentoring, and performance reviews
  • Other duties as assigned

Qualifications:

  • Minimum of 2 yrs in a clinical management role with direct reports
  • Minimum of 10 yrs experience in a clinical setting
  • Minimum bachelor's degree (B.A. or B.S., BSN is preferred) from a four-year college or university
  • Valid/current RN license in state of practice
  • Case Management training, certification preferred
  • Experience in an HMO/IPA/Managed Care setting preferred
  • Knowledge of long-term care, community resources, and cost-effective alternatives regarding patient care delivery systems
  • Knowledge of, clinical standards of care, NCQA requirements, CMS guidelines, and Medicaid/Medicare contracts and benefit systems is preferred
  • Knowledge of CPT, ICD-9 and HCPCS codes
    • Ability to work in a Windows based computing environment
    • Strong interpersonal and critical-thinking skills
    • Proven track record of leading and building teams to drive measureable results
    • Self-directed and committed to continuous improvement of processes and procedures
    • Ability to work and collaborate cross-functionally
    • Ability to adapt to a fast paced, changing environment
    • Comfort embracing and navigating ambiguity

    Req No.  2017-2023

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