About the Role

Provides clinical and administrative leadership to care management team(s). Responsible for direct daily oversight of both medical and behavioral health clinicians and non-clinical staff in the delivery of care management services to identified Plan members with a range of physical health, behavioral health and social service needs. Implements care management programs and ensures program operations and documentation support regulatory standards.

Essential Functions

• Prioritizes daily workflows, assignments and triage priorities to meet state and Federal regulatory requirements and established organizational performance metrics.
• Monitors performance and productivity of team and team members to ensure guidelines are followed and goals are met.
• Facilitates collaboration with internal partners for a coordinated approach to care coordination for members.
• Supports regionalized care team structure to coordinate care across IMC regions.
• Responsible for a strong understanding of health plan benefits for assigned line(s) of business.
• Participates in Care Management Rounds to support a productive and collaborative discussion and provide clinical input on cases.
• Responsible for onboarding new staff and monitoring performance to ensure competency of new skills.
• Conducts staff audits according to internal policies and procedures in order to identify opportunities for improvement and alignment with program expectations.
• Assists in the development of team metrics; implements workflows to achieve assigned metrics. Utilizes data to monitor clinician productivity.
• Assists management in the identification, implementation, and maintenance of standardized operations to ensure compliance standards are met.
• Works with management to establish efficiency and quality standards for the team; conducts routine audits and uses data to drive performance improvement.
• Reviews quality audits and shares results with associates in a timely manner; provides education and coaching to improve performance as needed.
• Employees are expected to report to work as scheduled, participate in all assigned meetings, and meet established performance and accountability standards.
• Ensures that staff are adequately trained to achieve goals and outcomes for the program. This includes onboarding new staff and ongoing training for existing staff.
• Assists in performing direct member outreach and care management activities as needed to support staff and the team.
• Other duties as assigned. Essential functions listed are not necessarily exhaustive and may be revised by the employer, at its sole discretion.

Qualifications
Education

• Bachelor's degree in nursing or a master's degree in social work and/or a related behavior health field required.

License, Certifications, and other Specialized Training

• Current, unrestricted RN license in the State of Washington OR
• Current, unrestricted LICSW license in the State of Washington required
• Case Management Certification required or obtained with the first 2years of employment.

Experience

• Minimum of three (3) years clinical experience in an acute care or public health setting, AND
• a minimum of three (3) years as a case manager in a Accountable Care Organization (ACO), Managed Care Organization (MCO) , or Behavioral Health Organization (BHO) required, AND
• Three (3) years supervisory or leadership experience in a healthcare or managed care setting preferred

Employment Eligibility

• Complete and successfully pass a criminal background check
• Has not been sanctioned or excluded from participation in federal or state healthcare programs by a federal or state law enforcement, regulatory, or licensing agency

Knowledge, Skills, and Abilities

• Knowledge of substance abuse recovery and mental health care models
• Experience with Washington state Medicaid requirements, CMS Medicare care management, and special needs plan (SNP) requirements preferred
• Ability to meet scheduled deadlines with minimal supervision
• Effective verbal and written communication skills
• Flexibility and willingness to work in a matrix-management environment
• Demonstrated organizational and time management skills
• Ability to handle multiple priorities in a fast-paced environment
• Ability to multi-task assignments on a frequent basis
• Demonstrated proficiency and experience with Microsoft Office products
• Knowledge of regulatory and certification requirements and their impact on the organization (for example, HEDIS, CAHPS, and NCQA)
• Knowledge in criteria set, including Milliman and InterQual, preferred
• Ability to work independently
• Collaborate with others in a respectful manner
• Perform all functions of the job with accuracy, attention to detail and within established timeframes
• Meet attendance and punctuality standards
• Demonstrate professional courtesy to others and ability to maintain confidentiality

SENSORY/PHYSICAL/MENTAL REQUIREMENTS

Sensory*:

• Speaking, hearing, near vision, far vision, depth perception, peripheral vision, touch, smell, and balance.

Physical*:

• Extended periods of sitting, computer use, talking and possibly standing
• Simple grasp, firm grasp, fine manipulation, pinch, finger dexterity, supination/pronation, wrist flexion
• Frequent torso/back static position; occasional stooping, bending and twisting
• Some kneeling, pushing, pulling, lifting and carrying (not over 25 pounds), twisting and reaching

Mental:

• Must be able to manage conflict, communicate effectively and meet time-sensitive deadlines

WORK ENVIRONMENT

Office environment with frequent environmental exposure to low-grade radiation from computer monitors; fast paced with frequent interruptions.

PROTECTED HEALTH INFORMATION (PHI) ACCESS

All information (written, verbal, electronic, etc.) that an employee encounters while working at CHPW is considered confidential. CHPW employees may encounter protected health information in the regular course of their work at and for CHPW. This position may be exposed to and required to deal with highly confidential and sensitive material and must adhere to CHPW policies, guidelines, and all applicable laws and regulations at all times.

*Candidates whose disabilities make them unable to meet these requirements are considered fully qualified if they can perform the essential functions of the job with reasonable accommodation.

This job description is intended to describe the general content and the requirements for satisfactory performance in this position. It is not to be construed as an exhaustive statement of the duties, responsibilities or requirements of this position.