Supv Case Mgr LTC - Gateway

Job ID: J126956
Company: Gateway Health Plan
Location: Home, DE, United States
Facility: Work From Home
Full/Part Time: Full time
Job Type: Regular
Posted at:

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Description

GENERAL OVERVIEW:  

The Supervisor will be responsible for managing a team of Case Managers charged with promoting quality member outcomes to optimize member benefits and to promote effective use of resources for members enrolled in DSHP Plus LTSS. In addition to providing direct oversight to Case Managers, the Supervisor must also meet all of the requirements of a Case Manager and be able to assist in the day to day responsibilities of a Case Manager as needed. This is a full time community based position requiring frequent travel within the assigned territory in Delaware. 

ESSENTIAL RESPONSIBILITIES: 

1. Managing a team of community based Case Managers. Promoting quality member outcomes to optimize member benefits and to promote effective use of resources. Acting as a role model to staff and assisting in the day to day activities as needed.

2. Ensuring care is medically appropriate, high quality, and cost effective.

3. Conducting frequent ride-alongs and shadowing of Case Managers for hands on support, quality assurance, and to identify training opportunities. Applying clinical knowledge to work with facilities and providers for care-coordination. Participating in rounds with the Medical Director.

4. Reviewing documentation and processes for consistent practice, and to identify opportunities for growth. Initiating and implementing process improvements.

5. Assisting Case Managers in finding solutions to challenging situations and overcoming obstacles to meeting member’s needs. Identifying and escalating issues appropriately. Suggesting new approaches to complex problems.

6. Assuring all staff achieve the minimal qualification of their position through ongoing staff development, counsel, individual and group education. Ensuring direct reports meet process and documentation in order to be compliant with regulatory agencies, including but not limited to: NCQA, URAC, CMS, DOH, and DOL. Developing and implementing modifications to ensure appropriate distribution of workload  in compliance with Delaware Case Manager caseload requirements

7. Recruiting, selecting, orienting, evaluating, counseling, and developing performance improvement plans; promoting and terminating per corporate policy; and encourage career development and support of staff.

8. Adhering to all company, State and Federal requirements related to privacy practices, HIPAA, and quality performance standards.

9. Performing other duties as assigned/requested.

III. QUALIFICATIONS:

Education, Licenses/Certifications, and Experience

Minimum

  • Bachelor's degree in Social Work and
    • Minimum of 3 years’ experience in long-term care, home health, hospice, public health, or assisted living

or

  • Master’s degree in Social Work and
    • Minimum of 1 year experience in long-term care, home health, hospice, public health, or assisted living

or

  • Registered Nurse or Licensed Practical Nurse and
    • Minimum of 2 years’ experience in long-term care, home health, hospice, public health, or assisted living

Preferred

  • One year of supervisory or managerial experience.
  • One year in home clinical or case management experience
  • Medicare and Medicaid experience
  • Managed care experience

Knowledge, Skills and Abilities 

  • Leadership skills and be able to relate to all levels of
    management and staff as well as individuals external to the corporation.
  • Leadership, collaboration, 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
  • Team player that possesses strong analytical and organizational skill
  • The ability to prioritize work demands and meet deadlines
  • Proficiency in PC-based word processing and database documentation (Word, Excel, Internet, Outlook)
  • Reliable transportation daily to be able to travel within assigned territory
  • Ability to meet regulatory deadlines.
  • Has a dedicated home work space used only for business purposes and is able to comply with all telecommuter policies.
  • Experience in geriatric special needs, behavioral health, home health
  • Understanding of the importance of cultural competency in addressing targeted populations.
  • Experience with electronic  documentation system(s)
  • Experience with cost neutrality and budgeting

IV. SCOPE OF RESPONSIBILITY 

Does this role supervise/manage other employees? Yes         

V. WORK ENVIRONMENT

Is Travel Required?

Yes

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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