Supervisor Case Management Molina Healthcare - Columbus, OH Responsible for overseeing the Integrated Case Management staff focused on assisting Molina Healthcare members with their health care needs to achieve optimal clinical, financial and quality of life outcomes. Monitors information daily as appropriate including member metrics and staff productivity. Evaluates the services provided and outcomes achieved by the team and recommends enhancements and/or improvements for programs and staff development to ensure consistent cost effectiveness and compliance with all state and federal regulations and guidelines in day-to-day activities. Essential Functions •Oversees, coordinates and monitors all Case Management team clinical and non clinical team activities to facilitate integrated proactive utilization management. •Functions as hands-on supervisor for daily integrated Case Management activities including Long Term Care and Behavioral Health. •Manages and evaluates team members in the performance of various case management activities. •Performs and promotes interdepartmental integration and collaboration to enhance the continuity of care for Molina members. •Works with the Manager of HCS to ensure adequate staffing and service levels, and maintains customer satisfaction by implementing and monitoring staff productivity and performance indicators. •Maintains effective team member relations. •Conducts regular staff meetings. •Assists with selection, orientation and mentoring of new team members. •Conducts performance evaluations in a timely manner. •Provides coaching, counseling and employee development and meets individually with staff at least monthly. •Recognizes exceptional employee performance. •Completes quality audit reviews for all Case Management staff. •Assists team members in improving skills, creativity and problem solving. •Collaborates with and keeps the Manager of Healthcare Services appraised of operational issues, staffing, resources, system and program needs. •Manages and completes assigned work plan objectives and projects in a timely manner. •Participates in committees, task forces, work groups and multidisciplinary teams as needed. •Maintains professional relationships with provider community and internal and external customers while identifying opportunities for improvement. •Oversees staff activities to ensure compliance with regulatory and accrediting standards. •Conducts self in a professional manner at all times. •Maintains cooperative and effective workplace relationships and adheres to company Code of Conduct. •Acts as an information and problem solving resource for Case Management team members. •Interacts with medical directors regularly, as necessary. •Facilitates open and timely communication between team members, other Molina employees and external customers. •Complies with required workplace safety standards. Knowledge/Skills/Abilities •Demonstrated ability to communicate, problem solve, and work effectively with people. •Skilled at supervising high functioning teams. •Able to use effective management principles. •Excellent organizational skill with the ability to manage multiple priorities. •Work independently and handle multiple projects simultaneously. •Knowledge of applicable state, and federal regulations. Knowledge of ICD-9, CPT coding and HCPC. Knowledge of SSI, Coordination of benefits, and Third Party Liability programs and integration. Familiarity with NCQA standards, state/federal regulations and measurement techniques. •In depth knowledge of CCA and/or other Case Management tools. •Ability to take initiative and see tasks to completion. •Computer skills and experience with Microsoft Office Products. •Excellent verbal and written communication skills. •Ability to abide by Molina’s policies. •Able to maintain regular attendance based upon agreed schedule. •Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA). •Skilled at establishing and maintaining positive and effective work relationships with coworkers, clients, members, providers and customers. Job Qualifications Required Education: Bachelor’s degree in Nursing (a combination of experience and AA education will be considered in lieu of Degree) or master’s Degree in Social Work or Master’s Degree in Gerontology or Master of Psychology Degree Note other alternative/options below. Required Experience: Five or more years of clinical experience with three or more years of case management experience. Or, MSW with 2 + years experience delivering case management in a Medical setting, in-patient psych setting, managed behavioral health setting, or managed care health plan, Or MS Gerontology with experience in Medical setting, or managed care health plan, or other case management setting that interfaces with medical providers. Or, Master of Psychology degrees, with a license, with case management experience Minimum 1 year of healthcare supervisory experience. Required Licensure/Certification: Active, unrestricted State Registered Nursing license in good standing or Master of Psychology with license or MSW with LCSW. Must have valid driver’s license with good driving record and be able to drive locally. Preferred Education: Master’s degree in Nursing. Preferred Experience: More than five years Case Management experience. Medicaid/Medicare Population experience. Preferred Licensure/Certification: Certified Case Manager. (CCM), Certified Professional in Healthcare Management Certification (CPHM) Certified Professional in Health Care Quality (CPHQ), or other healthcare or management certification. Additional Description State specific job description: · Supervises the day-to-day operations of the case management team function. · Oversees and monitors clinical and non-clinical team members · Training, coaching and counseling staff · Integration of case management activities internally and externally · Oversees staff activities to ensure compliance with regulatory standards · Oversees on-call quarterly rotation schedule for weekend and holiday coverage To all current Molina employees if you are interested in applying for this position please apply through the intranet job listing. Also, fill out an Employee Transfer Request Form (ETR) and attach it to your profile when applying online. Molina Healthcare offers competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE
Posted on: Mon, 14 Jul 2014 12:29:17 +0000
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