Responsible for the day to day operation and performance of the care management team. Support overall daily functions and tasks of assigned Program. Oversee the clinical operations and data collection for the individual programs and Accreditation responsibilities within the Care Management Program such as NCQA, Regulatory requirements, CNY Gold. Provide coaching and mentoring to team members to address performance related issues. Utilize problem solving abilities to create solutions to issues identified during day to day operations. Collaborate with the Care Management Managers/ Directors to address audit-related findings and implement performance improvement strategies. Collaborate with other functional areas within the department to ensure that the care management team is implementing EmblemHealth Health Plans policies, procedures and all regulatory mandates, consistent with Emblem Health Plans mission, vision, purpose and value statement. Perform member outreach and surveys as needed and as part of work time.
Supervise clinical care management staff and associated activities in compliance with regulatory and accredited requirements; ensure that all staff are performing optimally. Manages staff assignments to ensure they have an appropriate workload.
Monitor individual work assignments for timeliness and appropriateness of documentation in on-line data systems, and where appropriate, to ensure that documentation meets regulatory and accredited standards.
Collects and monitors program's outcome data and reporting requirements.
In collaboration with the managers, monitor employees' performance, key performance indicators, audits, case reviews, etc.
Complete/provide input into staff evaluations; perform corrective action and/or counseling as needed.
Perform member outreach (telephonic and in person) as needed to support staff.
Train employees in process operations; act as a preceptor to newly hired staff.
Perform other duties as assigned or directed.
Bachelor's degree in Nursing
4 - 6 years of relevant, professional work experience required
Demonstrated skill in managing workflows, processes, and staff, preferably in a healthcare provider environment required
Ability to effectively train and motivate staff; and to manage performance required
Strong problem-solving ability; experience in producing consistently excellent results required
Excellent written and verbal communication skills with all types and levels of audiences required
Proficiency with MS Office suite of applications (word processing, database/spreadsheet, presentation) required
Supervisory experience or specialized training required