Supervisor, Care Management
Company: Oklahoma Complete Health
Location: Stillwater
Posted on: November 20, 2023
|
|
Job Description:
You could be the one who changes everything for our 28 million
members as a clinical professional on our Medical Management/Health
Services team. Centene is a diversified, national organization
offering competitive benefits including a fresh perspective on
workplace flexibility. Position Purpose: Under the direction of the
Director of Care Management, the Supervisor of Care Management is
responsible for implementing the Care Management programs in
multiple environments including Prior Authorization, Concurrent
Review and Care Management. Manages the daily operational processes
to assure the continuum of care that addresses the ongoing needs of
the members served by the care management process. A patient
advocacy approach with a seamless integration of services is
required and must be balanced within the member---s benefit
structure. Emphasis will be placed on continuity of care, assisting
members in obtaining access to care, and member education. Directs
personnel supervision of associates to include hiring, training and
performance evaluations. Assures appropriate triage of members at
risk. Supervises the assessment of members--- situations and
functioning, assuring identification of individual needs. Assures
assessment information is used to develop a comprehensive care
management plan to address the members--- needs. Manages the
planning process to assure the specific objectives, goals and
actions are designed to meet the members--- needs as identified
throughout the planning process. Responsible for implementing and
coordinating activities that will lead to the accomplishment of
goals set forth in the care management plan. Performs resource
management, and organizes, secures, integrates and modifies
resources to meet the goals. Assures processes are in place to
identify deficits between benefits and member requirements, and
utilizes community and ancillary services to assure continuity of
care for the member. Performs the direct supervision of care
managers, assures the proactive identification of members at risk
and in need of care management services, and identifies educational
opportunities. Assesses caseloads and realigns assignments to meet
organizational needs. Works in collaboration with Medical
Informatics and the Quality Improvement departments and monitors
programs to meet the needs of our membership and those in the Care
Management process. Monitors information from all relevant sources
about the care management plan and activities to determine the
plan---s effectiveness. Performs the daily activities necessary to
evaluate the effectiveness of the care management plan at
appropriate intervals, and determines if outcomes were successful
and goals were met. Works in collaboration with the Care Management
Directors in each state to identify areas of opportunity and/or
provider education. Maintains Care Management vendor relationships
on a daily and aggregate basis to assure the care given to our
members is appropriate and compliant with PHS policies and
governmental regulatory requirements. Communicates with providers,
members and community resources as necessary to support the
planning, implementation and evaluation of the patient---s plan of
care. Performs audit activities as required, and participates in
establishment of corrective action as necessary. Assures the use of
appropriate criteria when making decisions. Performs Care
Management activities as required. Education/Experience: CCM,
Baccalaureate degree preferred; MSW with appropriate care
management experience may be considered. Five years of clinical
experience and at least two years of supervisory experience,
preferably with HMO experience in a medical management capacity.
License/Certification: Current, valid and unrestricted professional
licensure is required; Current, valid and unrestricted RN preferred
For Shared Services: Clinical licensure for multiple states is
required For Illinois plan only: Five years of clinical experience
required and two years of supervisory experience preferred,
preferably with HMO experience in a medical management capacity.
Our Comprehensive Benefits Package: Flexible work solutions
including remote options, hybrid work schedules and dress
flexibility, Competitive pay, Paid time off including holidays,
Health insurance coverage for you and your dependents, 401(k) and
stock purchase plans, Tuition reimbursement and best-in-class
training and development. Centene is an equal opportunity employer
that is committed to diversity, and values the ways in which we are
different. All qualified applicants will receive consideration for
employment without regard to race, color, religion, sex, sexual
orientation, gender identity, national origin, disability, veteran
status, or other characteristic protected by applicable law.
Keywords: Oklahoma Complete Health, Stillwater , Supervisor, Care Management, Executive , Stillwater, Oklahoma
Click
here to apply!
|