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Manager, Field Care Management - North Florida

Company: WellCare
Location: Tallahassee
Posted on: August 16, 2019

Job Description:

MUST RESIDE IN NORTH FLORIDA AREAManages the day-to-day activities of the Field Care Management Team. Ensures the case management process of assessing, planning, implementation, coordination, monitoring, and evaluating services and outcomes is pursued to maximize the health of the Member. Promotes effective healthcare utilization, monitors health care resources and assumes a leadership role within the Interdisciplinary Care Team (ICT) to achieve optimal clinical and resource outcomes for member. Oversees the socio economic needs and services of selected member populations across the continuum of illness. Provides ongoing support and oversight to staff.DEPARTMENT: HEALTH SERVICESREPORTS TO : DIRECTOR, FIELD CARE MANAGEMENTLOCATION: NORTH FLORIDA Essential Functions:

  • Provides ongoing consultation to the care management team and reviews caseloads on an ongoing basis, both through regular face-to-face supervision sessions and review of management reports and deadlines.
  • Assists Medical Director and Dir, Field Service Coordination in creating department goals, objectives and metrics.
  • Oversees the implementation of programs and strategies.
  • Develops and implements case management workflows and policies & procedures.
  • Proactively monitors and tracks appropriate metrics to drive up efficiency.
  • Perform audits of assessments, care plans and service notes to verify cases are properly established and that member coordination activities are occurring and appropriately documented.
  • Coordinates team activities to meet contractual company deadlines and resolves interpersonal conflicts.
  • Partners & collaborates with other departments cross functionally regarding care and case management and/or Health Service initiatives.
  • Directs work assignments, measures results and initiates personnel actions as required.
  • Develops, implements and manages process improvement initiatives.
  • Monitors associate performance and conducts counseling/corrective action procedures when required. Identifies concerns, brings issues to management's attention and offers suggestions for improvement.
  • Reviews time records, sets schedules and approves all vacation/time off requests for subordinate associates.
  • Provides training and guidance to new and current care management team regarding policy & procedure, systemic tools, workload and care/case plan development.
  • Answers all questions and assists peers and management with delegated tasks or projects.
  • Ensures compliance with all state and federal regulations as well as Corporate guidelines in day-to-day activities.
  • Performs special projects as needed. Candidate Education:
    • An Associate's Degree in Nursing, Health and Human Services or a related field (Required)
    • A Bachelor's Degree in Nursing or Health Administration (Preferred)
    • Other For Florida Managed Long Term Care program, a Master's degree in human service, social science or health field plus a minimum of 3 years' experience in case management is required.
    • OR Bachelor's degree in human service, social science or health field plus a minimum of 6 years' experience in case management is required . Candidate Experience:
      • 5 years of experience in case management, clinical acute care, home health, hospice, physician's office or public health (Required)
      • 3 years of experience in managed care (Required)
      • 1 year of management experience (Required)
      • Other NCQA, EQRO accreditation experience (Preferred)
      • Other Specialty Experience - In consideration of a specialty program or as a specific discipline leader ie Obstetrics, must have at least 5 years of experience or hold a national certification in that area of specialty (in states where applicable) (Preferred)
      • Other For Florida Managed Long Term Care program, 1 years experience in working with the elderly and disabled population and case management experience.(Required)
      • Other Associates supporting Florida's Children's Medical Services (CMS) will have a minimum of: five (5) years management/supervisory experience in the health care field, and three (3) years' experience providing care coordination and two (2) years in managed care or children's services (Required)
      • Other Associates supporting Florida's Children's Medical Services (CMS) to have experience working: in care management, children's specialty clinics, or with Patient Centered Medical with community and family-based services and experience in working across child serving systems recommended (Preferred)Candidate Skills:
        • Ability to communicate and make recommendations to upper management
        • Demonstrated time management and priority setting skills
        • Ability to lead/manage others
        • Ability to create, review and interpret treatment plans
        • Demonstrated negotiation skills
        • Demonstrated problem solving skills
        • Demonstrated interpersonal/verbal communication skills
        • Knowledge of community, state and federal laws and resources
        • Ability to effectively present information and respond to questions from families, members, and providers
        • Demonstrated written communication skills
        • Knowledge of healthcare delivery
        • Ability to multi-task
        • Demonstrated written communication skills
        • Other Ability to lead and manage others in a metric driven environment
        • Ability to implement process improvements
        • Other Knowledge of medical terminology and/or experience with CPT and ICD 10 coding Licenses and Certifications:A license in one of the following is required:
          • Other One of the following licenses is required
          • Licensed Registered Nurse (RN)
          • Licensed Certified Social Worker (LCSW)
          • Licensed Clinical Mental Health Counselor (LCMHC)
          • Other Maintain required contact hours to fulfill regulatory requirements
          • Certified Case Manager (CCM) preferred
          • Master's level Behavioral Health clinical licensure is required.
          • Other Associates supporting Florida's Children's Medical Services (CMS) must be a Licensed Registered Nurse (RN) or Licensed Certified Social Worker (LCSW) Technical Skills:
            • Microsoft Excel
            • Microsoft Word
            • Microsoft Outlook About usHeadquartered in Tampa, Fla., WellCare Health Plans, Inc. (NYSE: WCG) focuses primarily on providing government-sponsored managed care services to families, children, seniors and individuals with complex medical needs primarily through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans, as well as individuals in the Health Insurance Marketplace. WellCare serves approximately 5.5 million members nationwide as of September 30, 2018. WellCare is a Fortune 500 company that employs nearly 12,000 associates across the country and was ranked a "World's Most Admired Company" in 2018 by Fortune magazine. For more information about WellCare, please visit the company's website at . EOE: All qualified applicants shall receive consideration for employment without regard to race, color, religion, creed, age, sex, pregnancy, veteran status, marital status, sexual orientation, gender identity or expression, national origin, ancestry, disability, genetic information, childbirth or related medical condition or other legally protected basis protected by applicable federal or state law except where a bona fide occupational qualification applies. Comprehensive Health Management, Inc. is an equal opportunity employer, M/F/D/V/SO.

Keywords: WellCare, Tallahassee , Manager, Field Care Management - North Florida, Executive , Tallahassee, Florida

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