Manager, Care Management

Manager, Care Management

Remote in WA, OR, UT, ID. May be required to come to the office on occasion.

The manager of care management plans, directs, and manages the activities of the care management professional and support staff. Oversees staff directly or through subordinate supervisor(s). Provides leadership to set performance standards and ensure effective and efficient execution of care management programs across all Cambia plans, including case management, disease management and care coordination. Represents the department in interactions with all levels of management, vendor partners, clients, providers, government officials, and outside consultants.

Responsibilities

• Leads the development and execution of effective care management policies, procedures and standards.

• Oversees the implementation of policy updates or process improvements as needed to ensure quality and service excellence.

• Handles all management level responsibilities for staff, including performance reviews, employee development, hiring, firing, coaching, counseling, and retention. Develops supervisors and participates in talent management activities.

• Regularly communicates organizational objectives and team goals. Monitors results and metrics to ensure deliverables are met and compliance with department and regulatory standards. Collaborates with other leaders and across departments to resolve issues.

• Manages financial targets and department budget, authorizes expenditures, monitors workforce allocation and resources, and oversees project plans.

• In conjunction with division leadership, establishes long-term goals for department and adapts operational plans as changes occur.

• Creates visibility and support for care management programs. Develops resource materials and provides education and communication about programs to employees, providers and community stakeholders.

• Maintains clinical competency and keeps current on medical practices, procedures and industry trends.

• May develop and present educational updates to other departments.

• Oversees development and implementation of department programs. Responsible for program quality and successful outcomes of programs.

Minimum Requirements

• Ability to identify issues, opportunities, and effective solutions and collaborate with other departments to improve processes and/or results.

• Demonstrates competency in resource and project management: budgeting, organizing work, providing leadership to staff, establishing measures for success, and managing deliverables.

• Ability to develop and lead a team including: hiring, goal setting, coaching and development (including supervisors and/or employees who may be in multiple locations or work remotely).

• Ability to communicate effectively, verbally and in writing, including meeting facilitation and presentations with employer or provider groups.

• Familiar with health insurance industry trends and technology.

• Demonstrates competency in clinical case management and utilization management practices.

• Experience using population statistics and their application in care management programs.

Normally to be proficient in the competencies listed above

A Manager of Case Management would have a bachelor’s degree in nursing or related field, master’s preferred, 7 years of healthcare or clinical care experience and 5 years of leadership experience or equivalent combination of education and experience.

Required Licenses, Certifications, Registration, Etc.

• Current unrestricted Registered Nurse (RN) License in a state or territory of the United States.

• Certification as a case manager from the URAC-approved list of certifications preferred.

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