Job ID: J126956
Company: Gateway Health Plan
Location: Home, DE, United States
Facility: Work From Home
Full/Part Time: Full time
Job Type: Regular
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.
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.
Education, Licenses/Certifications, and Experience
Knowledge, Skills and Abilities
IV. SCOPE OF RESPONSIBILITY
Does this role supervise/manage other employees? Yes
V. WORK ENVIRONMENT
Is Travel Required?
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