About the Role
The Manager, Community Based Care Management provides operational management and oversight for providing Company members with the right care at the right place at the right time and assisting them to achieve optimal clinical, financial, and quality of life outcomes.
Essential Functions:
Oversee a team of clinical and nonclinical staff to achieve quality service level and production expectations
Facilitate/promote problem identification, analysis, and resolution to improve member experience, ensuring compliance with state and federal regulatory and accrediting standards and implementation of the Care Model
Manage and evaluate team member performance; provide coaching, counseling, employee development, and recognition; ensure ongoing, appropriate staff training; and oversee the selection, orientation, and mentoring of new staff
Ensure adequate staffing and service levels and maintain customer satisfaction by implementing and monitoring staff productivity and other performance indicators
Ensure completion of staff quality audit reviews. Evaluate services provided and outcomes achieved, and recommend enhancements/improvements for programs and staff development to ensure consistent cost effectiveness and compliance with all state and federal regulations and guidelines
Maintain professional relationships with the provider community, internal and external customers, and state agencies as appropriate, while identifying opportunities for improvement
Utilize available tools/platforms for efficiencies
Understand the mission and ensure alignment of compliance-based activity in strategic planning/department goal-setting and regional market support
Assist in new market development and implementation of department initiatives
Perform any other job duties as requested
Requirements
Education and Experience:
Bachelor’s degree or equivalent years of relevant work experience is required
A minimum of five (5) years of managed healthcare experience is required
A minimum of two (2) years of supervisory experience is required
Managed care experience is preferred
Competencies, Knowledge and Skills:
Display a customer service, member-focused orientation
Strong team and staff development skills
Strong collaboration and conflict resolution skill sets
Ability to develop, prioritize, and accomplish goals/time management
Strong decision-making and problem-solving skills
Exceptional communication skills (both written and verbal) with the ability to present information in a variety of formats to all levels
Strong ability to teach best practices and engagement strategies for successful member participation (including motivational interviewing, best practice engagement techniques)
Ability to work in a fast-paced environment
Ability to work independently and within a team environment
Advanced knowledge of Microsoft Word, Excel, PowerPoint, and Visio
Licensure and Certification:
Active, unrestricted State Licensed Practical Nurse (LPN), Registered Nurse (RN) license, Social Work license, or Counselor license is preferred
Healthcare or Management certification is preferred
To help protect our employees, members, and the communities we serve from acquiring communicable diseases, Influenza vaccination is a requirement of this position. Company requires annual proof of Influenza vaccination for designated positions during Influenza season (October 1 – March 31) as a condition of continued employment. Employees hired during Influenza season will have thirty (30) days from their hire date to complete the required vaccination and have record of immunization verified.
Company adheres to all federal, state, and local regulations. Company provides reasonable accommodations to qualified individuals with disabilities or medical conditions, sincerely held religious beliefs, or as required by state law to enable the employee to perform the essential functions of the position. Requests for accommodations will be completed through an interactive review process.
Working Conditions:
Regular and frequent travel to different work locations, including homes, offices, or other public settings, as required by the needs of the business. May be exposed to weather conditions typical of the location.
Must reside in the same territory they are assigned to work in; exceptions may be considered due to business need
Required to use general office equipment, such as a telephone, photocopier, fax machine, and personal computer
About the Company
RepuCare, a certified Woman-Owned Business Enterprise (WBE), is a leader in delivering innovative workforce solutions across the healthcare industry. We are proud to partner with a large, nationally recognized managed care organization to recruit a dedicated Case Manager to join their dynamic team.