Case Management Team Leader

QUALIFICATIONS:

• A current, unrestricted, RN licensure.
• Two years full-time equivalent of direct clinical care to the consumer
• Previous experience in worker's comp case management preferred
• At least three years prior supervisory experience or current employment with Sheakley UniComp.
• If they have directly supervised the case management process for at least three (3) years with Sheakley, hold a certification in case management from the URAC approved list of certifications, CCM, CDMS, CRC, CRRN, COHN, CMAC, RN, CRN, BC.
• Excellent leadership and communication skills
• Maintain continuing education for licensure and or certification
• Practice within the Scope of Professional Practice as designated by applicable Licensing boards
• Demonstrates self directed learning and participates in continuing education for Professional development

ROLE AND RESPONSIBILITIES FOR THE CM TEAM LEADER:

• Reports directly to the Director of Client Programs
• Direct day to day supervision for Nurse Case Managers
• Responsible for overseeing day to day case management procedures and policies to maintain compliance with BWC Policy reference guide and URAC guidelines
• Acts as a resource for the Case Managers, first point of contact for clinical clarification
• Responsible for monitoring medical industry changes and updates on how it may be applied internally or externally for improved staff performance and/ or client retention
• Oversees in development, coordination and implementation of orientation and in-services for the case management staff
• Develops and maintains a good working relationship with other department team leaders in the MCO
• Oversees & reviews case management audits to determine reasonableness of treatment, timeliness of RTW, appropriateness of care and overall performance- including meeting and exceeding MoD measurements
• Chairs committees as appropriate to meet URAC standards and BWC guidelines and meet goals of the HPP program
• Member of Total Quality Management Committee
• Actively participates in the development of clinical guidelines and incorporates process into the case management role
• Ensures case managers are provided current case management resources and applicable resources
• Ensures that case managers assess, plan and deliver appropriate communication to all points of contact
• Obtains feedback on support staff job performance from case managers who receive direct support from and interact on a regular basis
• Responsible for establishing relationship with vocational vendors as to appropriateness and eligibility of referrals
• Assesses case load status; assigns and reassigns employer policies to ensure equitable distribution and evaluate acuity of cases
• Oversees current and provides input on CM practices, MCO Policy & Procedure, BWC Guidelines, ODG
• Responsible for daily monitoring of best practices for Case Management as it pertains to Ohio Workers' Comp including a safe and timely return to full duty.
• Demonstrate to management on a regular basis team and individual Case Managers' movement in performance results to meet and exceed company goals.
• Sets an example by adhering to Sheakley handbook and Sheakley UniComp Time Memo
• Medical oversight of Case Management in accordance with URAC standards
• Consistently evaluate staff for attendance, performance and conduct issues and timely correct issues
• Ensures that updates related to organizational goals and organizational changes are communicated to case management staff
• Oversees clinical, policy and procedural training for all clinical and non-clinical staff for case management services provided. May be asked to provide additional training to other staff members
• Responsible for oversight of clinical decision-making aspects of the case management program
• Understands and upholds Sheakley's philosophy and demonstrates commitment to the Company Core Values
• Ability to hold multi-state licensure
• Employee may be asked to travel from time to time to attend employer meetings or other offsite functions
• Supports all areas of Case Management, including but not limited to the case managers, CAT Coordinator, Case Manager Educator, Case Manager Quality Analyst and URAC, to ensure all are compliant and timely with all requirements
• Participates and represents Sheakley UniComp in any BWC and URAC audits
• Ability to function as a Case Manager and any other duties as assigned

This job description is not intended to be all-inclusive, and the employee will also perform other reasonably related business duties as assigned by the immediate supervisor and other management.