Skip To Content
Laptop
J213121

Manager Complex Case Management

Highmark Inc.

  • Company Highmark
  • Home, PA
  • Clinical Services
  • Full time
  • Day (United States of America)

Company :

Highmark Inc.

Job Description : 

JOB SUMMARY

This job will lead a team of Registered Nurse Complex Case Managers that deliver case management services to a specified panel of the Organization's members that range in health status/severity and clinical needs.  Accountable for daily operation of unit including staffing and scheduling to ensure that member outreach is effective and completed within defined time-frames and according to established processes.  This job ensures that team members are clinically competent and adequately trained in order to achieve member engagement targets as well as defined clinical and financial outcomes.  Establishes and monitors individual and team performance goals providing feedback and taking action to ensure that goals are achieved.

ESSENTIAL RESPONSIBILITIES

  • Perform management responsibilities to include, but are not limited to: involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity.
  • Plan, organize, staff, direct and control the day-to-day operations of the department; develops and implements policies and programs as necessary; may have budgetary responsibility and authority.
  • Assist with focusing activities toward a strategic direction as well as develop tactical plans, drive performance, and achieve targets, in collaboration with the Director,
  • Ensure that team members are clinically competent and adequately trained in motivational interviewing and other engagement techniques in order to achieve the market’s engagement and clinical targets for assigned population.  Ensures on-going staff development through education and opportunities for professional development.
  • Review department performance in relation to established metrics and implements changes in collaboration with other multidisciplinary team managers to effect continual improvement in the services provided.
  • Lead/participate in both departmental and interdepartmental work groups to continually enhance the delivery of programs and services and proactively respond to changing client and market expectations.
  • Participate in preparation of department budget.  Makes budgetary recommendations and projections.  Monitor, verify, and reconcile expenditures of budgeted funds.  Identify cost savings opportunities within the department and/or operations, in collaboration with the Director,
  • Ensure that all services are delivered consistent with applicable internal policies and procedures as well as applicable CMS, state, local, and regulatory agency requirements and applicable standards of practice for case management.
  • Other duties as assigned or requested.

REQUIRED EDUCATION

  • Bachelor's Degree in Nursing

Substitutions

  • 6 years of experience in the Healthcare field

Preferred

  • Master's Degree in Nursing

EXPERIENCE

Required

  • 7 years of any combination of clinical and case management
  • 3 years of management/supervisory or leading/working on project teams

Preferred:

  • Working with the healthcare needs of diverse populations
  • Understanding of the importance of cultural competency in addressing targeted populations

SKILLS

  • Written and verbal presentation skills, negotiation skills, and skills in positively influencing others with respect and compassion
  • Excellent interpersonal and communication skills and the ability to work in a matrix management environment
  • Understanding of healthcare costs and the broader healthcare service delivery system
  • Strong analytic skills with ability to interpret, evaluate and act on productivity, clinical and financial data
  • Proficient computer skills, including Microsoft Office products. Proficiency in MS Excel and enhanced data and statistical analysis skills
  • Excellent interperson/consensus building skills as well as the ability to work with a variety of internal and external colleagues from all levels of an organization
  • Ability to work in a high performing team environment that requires flexibility
  • Excellent organizational, time management and project management skills  Demonstrated ability to handle multiple priorities in a fast paced environment

Required Licensure

Registered Nurse

Preferred

Certification in Case Management

LANGUAGE REQUIREMENT ( other than English )
None

TRAVEL REQUIREMENT:

0% - 25%

PHYSICAL, MENTAL DEMANDS AND WORKING CONDITIONS

Position Type

Office-Based

Teaches/Trains others regularly

Rarely

Travels regularly from the office to various work sites or from site-to-site

Rarely

Works primarily out-of-the office selling products/services (Sales employees) -Does Not Apply

Physical Work Site Required

No

Lifting: up to 10 pounds 

Rarely

Lifting: 10 to 25 pounds 

Rarely

Lifting: 25 to 50 pounds 

Rarely

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement: This position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements. 

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, age, 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, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability. 

EEO is The Law

Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled/Sexual Orientation/Gender Identity ( https://www.eeoc.gov/sites/default/files/migrated_files/employers/poster_screen_reader_optimized.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 contact HR Services Online at HRServices@highmarkhealth.org

California Consumer Privacy Act Employees, Contractors, and Applicants Notice


Thumbnail Join Talent Community@2X

Connect with a career that’s right for you.

Introduce yourself and we'll get in touch monthly to share career insights and company news.

Join Our Talent Community