Supervisor Care Coordination

Job ID: J118900
Company: Gateway Health Plan
Location: Home, AR, United States
Facility: Work From Home
Full/Part Time: Full time
Job Type: Regular
Posted at:

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Description

JOB SUMMARY

This job functions as the Supervisor Care Coordination for the Arkansas PASSE (Forevercare) line of business and manages a team of clinicians charged with promoting quality member outcomes, to optimize member benefits, and to promote effective use of resources.   The incumbent supports and oversees providers managing care coordination services.  Ensures that care meets the care coordination needs of the member, is medically appropriate, high quality, and cost effective. Conducts oversight, development and maintenance of the department's Care Coordination processes. This may include utilization management, strategic planning, care cost initiatives, system development and quality outcomes. Hires, trains, coaches, counsels, and evaluates performance of direct reports.  Evaluates need for, and subsequently develops corrective action plans with providers not meeting care coordination expectations.  Ensures compliance with NCQA, URAC, CMS, DOH, and DOL regulations, as well as State Contract requirement. Works closely with other departments within the corporation to resolve issues and ensure activities coincide with Care Coordination processes.

ESSENTIAL RESPONSIBILITIES

  • Manage and coordinate all department activities; staff education, policy and procedure development and revision, individual staff audits, oversees overall operations to ensure compliance to standards. 
  • Ensure appropriate distribution of workload; monitors/tracks staff completion of assigned work.
  • Support and oversee providers delivering Care Coordination services.
  • Develop and implement modifications needed, to workload plan, to ensure completion and appropriately coach/counsel staff.
  • Act as a role model to staff and be able to assist in the day to day activities as needed. 
  • Provide service support, training and performance metrics/statistics, to the team, in addition to initiating and implementing process improvements.
  • Recruit, select, orient, evaluate, counsel, and develop performance improvement plans; promote and terminate per corporate policy; and encourage career development and support of staff.
  • Identify and escalate issues appropriately.
  • Apply clinical knowledge to work with facilities and providers for care-coordination.
  • Plan for and conduct staff meetings that assure corporate and operational communication supported by meeting minutes; and provide an open forum for issues and problem solving.
  • Suggest new approaches to complex problems.
  • Identify appropriate targets, measure outcomes and establish plans to negate variances in quality, staff retention, finance and customer satisfaction. 
  • Provide direct reports with guidance and educational tools in order to ensure compliance with NCQA, URAC, DOH, DOL and CMS.
  • Review and provide input into the oversight of policies and procedures to support regulatory requirements related to Care Coordination. 
  • Develop and implement appropriate audit requirements in order to ensure compliance with all staff activity related to Care Coordination.  
  • Ensure that all staff achieves the minimal qualification of their position through ongoing staff development, counsel and motivate employees, evaluate employees, investigate complaints or performance concerns; implement disciplinary action as needed and in consultation with appropriate authority and Employee Relations.
  • Display effective communication skills.
  • Maintain consistent and open lines of communication with internal and external customers.
  • Communicate changes in processes and programs in order to enhance a share vision and mission.
  • Effectively communicate outcomes, data analysis, complex processes and action plans to division/unit staff, corporate partners, and external customers. 
  • Facilitate and lead informational and educational meetings for internal and external customers.
  • Accountable for special projects and enhanced activities within the department.
  • Participate in the development and implementation of department/division projects. 
  • Implement integration processes and planning activities. 
  • Other duties as assigned or requested.

EDUCATION

Required

  • High School Diploma/GED

Substitutions

  • None

Preferred

  • Bachelor's Degree in Nursing

EXPERIENCE

Required

  • 3 -5 years in leadership or supervisory role
  • 3-5 years in a Clinical role
  • 3 - 5 years in Care Coordination, Case Management or Managed Care

Preferred

    LICENSES AND CERTIFICATIONS

    Required

    • None for this Contract

    Preferred

    • None

    SKILLS

    • Experience in workforce development and resource management with excellent team building and professional development skills
    • Must demonstrate excellent leadership skills and be able to relate to all levels of management and staff as well as individuals external to the corporation
    • Experience in staff/project management
    • Strong leadership, collaboration, l and motivational skills
    • Ability to multi task and perform in a fast paced, and often intense environment
    • Excellent written and verbal communication skills
    • Ability to analyze data, measure outcomes and develop action plans
    • Be enthusiastic, innovative and flexible
    • Team player that possesses strong analytical and organizational skill
    • The ability to prioritize work demands and meet deadlines
    • Excellent computer and software knowledge and skills

    Languages (Other than English)

    None

    Travel Requirement

    0% to 25%

    PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

    Position Type

    Office-Based

    Teaches/trains others regularly

    Rarely

    Travel regularly from the office to various work sites or from site-to-site

    Occasionally

    Works primarily out-of-the office selling products/services (sales employees)

    Does Not Apply

    Physical work site required

    Yes

    Lifting: up to 10 pounds

    Occasionally

    Lifting: 10 to 25 pounds

    Rarely

    Lifting: 25 to 50 pounds

    Does Not Apply

    Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

    Compliance Requirement: This position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

    Unusual Working Conditions
    Possible co-location at provider site; Field-based

    Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
    EEO is The Law
    Equal Opportunity Employer Minorities/Women/ProtectedVeterans/Disabled/Sexual Orientation/Gender Identity (http://www1.eeoc.gov/employers/upload/eeoc_self_print_poster.pdf)
    We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact number below.
    For accommodation requests, please call HR Services at 844-242-HR4U or visit HR Services Online at HRServices@highmarkhealth.org

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