The Senior Care Manager is responsible for the mentoring, training and supervision of care management staff and oversight of staff caseloads of members who have mild to complex medical and mental/behavioral health needs. This position has a broad knowledge base related to the needs of the Medicaid population and is an integral member of the Care Management Leadership team. The Senior Care Manager supports the operations of the Care Management Department through monitoring of staff’s adherence to quality and productivity standards; assisting with responding to member’s needs; and providing clinical supervision and leadership for compliance and performance improvement
Essential job duties:
1. Manages and assumes responsibility for day to day operations of an assigned team
2. Reviews cases regularly with staff; acts as a clinical consultant regarding care management issues; guides clinical staff with review of assessments and care plans, evaluates utilization reviews and/or documentation
3. Assists with the development of care coordination and care management activities that supports the health plans contract requirements
4. Assists Director in establishing, implementing, and ensuring care management policies, practices, and procedures are in place
5. In conjunction with VP and Director, coordinates, develops and implements action plan to respond to areas of need
6. Leads and offers expert guidance and direct supervision to the team in aspects of care management: assessment, planning and implementation, coordination
7. Assist the team with monitoring, and evaluation of options and services to meet the routine and complex health and behavioral health care needs of members
8. Monitors work performed by team members according to organization, department and community standards
9. Monitors productivity through the use of various reports to support appropriate outcomes and assign corrective action plans to staff as needed for immediate review and resolution
10. Conducts regular team meetings in accordance with contractual agreement and as needed
11. Completes all annual performance reviews by due date
12. Applies advanced problem-solving and analytical skills to evaluate and address complex situations involving members, providers, staff and community professionals
13. Submits routine and special reports as assigned or requested.
14. Participates in internal and external multidisciplinary rounds
15. Attends/conducts meetings internally or externally with other government agencies or community organizations involved with enrollees in the health plan as needed
16. Performs audits of member records on a weekly basis
17. Provides a level of oversight that assist the team members in maintaining caseload and contractual compliance metrics
1. Three years progressive supervisory experience
2. Three to five years of related experience in managed care and /or care management
3. Understanding of Medicaid benefits
4. Excellent verbal and written communication skills
5. Familiarity with computer systems and applications. Computer literate in Microsoft suite
6. Strong organizational skills
7. Ability to interpret and apply departmental requirements
8. Ability to make sound decisions and use good judgment
9. Must be able to work under pressure and meet deadlines, while maintaining a positive attitude and providing exemplary customer service
10. Ability to work independently and to carry out assignments to completion within parameters of instructions given, prescribed routines, and standard accepted practice
Licensed in DC as a Social Worker (LICSW), Registered Nurse (RN), or Licensed Professional Counselor (LPC). Certification in Case Management preferred.
Bachelor’s degree required. Master’s degree preferred.
*Note: Master’s Degree required for identified groups of members per CASSIP contract
DC Residents are encouraged to apply!