Supervisor Case Manager Long-term Care - Delaware

Overview

This position manages a team of Case Managers charged with promoting quality member outcomes to optimize member benefits and to promote effective use of resources for members enrolled in DSHP Plus LTSS. Provides direct oversight to Case Managers and can assist in the day to day responsibilities of a Case Manager as needed. This is a full time community based position requiring frequent travel within the assigned territory in Delaware.

Responsibilities

• Manage a team of community based Case Managers.
• Promote quality member outcomes to optimize member benefits and to promote effective use of resources.
• Act as a role model to staff and assist in the day to day activities as needed.
• Ensure care is medically appropriate, high quality, and cost effective.
• Conduct frequent ride-alongs and shadowing of Case Managers for hands on support, quality assurance, and to identify training opportunities.
• Apply clinical knowledge to work with facilities and providers for care-coordination.
• Participate in rounds with the Medical Director.
• Review documentation and processes for consistent practice, and to identify opportunities for growth.
• Initiate and implement process improvements.
• Assist Case Managers in finding solutions to challenging situations and overcoming obstacles to meeting member’s needs.
• Identify and escalate issues appropriately.
• Suggest new approaches to complex problems.
• Ensure all staff achieve the minimal qualification of their position through ongoing staff development, counsel, individual and group education.
• Ensure direct reports meet process and documentation in order to be compliant with regulatory agencies, including but not limited to : NCQA, URAC, CMS, DOH, and DOL.
• Develop and implement modifications to ensure appropriate distribution of workload in compliance with Delaware Case Manager caseload requirements.
• Recruit, select, orient, evaluate, counsel, and develop performance improvement plans; promote and terminate per corporate policy; and encourage career development and support of staff.
• Adhere to all company, State and Federal requirements related to privacy practices, HIPAA, and quality performance standards.
• Perform other duties as assigned / requested.

Qualifications

Required

Or

Or

Substitutions

Preferred

Skills

Scope of Responsibility

Does this role supervise / manage other employees?

Yes

Work Environment

Is Travel Required?

Yes

Disclaimer : The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement : This position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with HIPAA as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.

Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Pay Range Minimum : 67,500.00

Pay Range Maximum : 126,000.00

Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.

Highmark Health and its affiliates prohibit discrimination based on protected veterans or individuals with disabilities and prohibit discrimination based on any category protected by applicable federal, state, or local law.

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