Manager Case Management - Remote (PA/NJ/DE)

Under the leadership of the Director of Case and Condition Management, the Manager, Case Management provides leadership and has overall operational day-to-day responsibility for the effectiveness of case/disease management activities across the continuum of health to assist staff in meeting customers’ needs and achieve departmental goals.   The Manager is responsible for ensuring that the screening, assessment, planning, facilitating, monitoring and adjustment activities for members in case/disease management are performed appropriately, making recommendations for program changes when indicated.  The Manager is also responsible for assuring that all case and disease management activities are compliant with the standards set forth by NCQA and other applicable accrediting bodies.

Major responsibilities include, but are not limited to:

• Manages the recruitment, staffing and evaluation process to ensure staff competency, development and enrichment.
• Oversees the front-line CM/DM clinical and non-clinical staff and all activities; monitoring and adapting schedules to meet department goals and objectives.
• Ensures that new employees follow appropriate standards and policies and works to develop associates.
• Monitors and evaluates the training and development needs of the department to ensure the optimal level of performance.   
• Ensures that the case/disease management staff perform all key functions effectively and when indicated, makes recommendations for improvement.
• Acts as a resource using focused professionalism and effective interactions.
• Prepares and contributes unit specific budget data for the Director during annual budget cycles and assures unit keeps within approved yearly budget.
• Monitors all performance indicators and standards to ensure each is achieved or exceeded.
• Oversee the monthly audit process, identifying strengths and opportunities for improvement, and provides one-on-one feedback to staff promptly to ensure continuous performance improvement.
• Reviews any quality issues of the inbound queue process and performs/directs re- education as needed. 
• Performs probationary, interim, and annual staff reviews and develops corrective action plans when indicated.
•  Identifies individuals who exhibit a variation from standard company policy and counsels individuals in accordance with established policies.
• Builds team spirit and interdepartmental rapport, using effective problem solving and motivational strategies.
• Represents the department as a Subject Matter Expert
• Serves as alternate for internal workgroups when the Director is unable to attend or when requested.
• Other duties as assigned.

EDUCATION AND EXPERIENCE:

·    Current, active, and unrestricted licensure or certification in a health or human services discipline that allows the professional to conduct an assessment independently as permitted within the scope of practice of the discipline;  

·    Three or more years experience with direct patient/member care

·    Two or more years experience in a supervisory/leadership role required. 

SKILLS:

·    Must have superior communication, team building, and problem-solving skills.  Ability to interact with all levels of management is necessary.

·    The ability to thrive in ambiguous and fast-paced environment crucial for success.

·    Demonstrated success in taking risks and confronting challenging scenarios with

·    professionalism, integrity and diplomacy.

·    Excellent communication, interpersonal and analytical skills required.  Strong organization skills are essential.