Highmark Bcbsd Inc.
Job Description :
This job manages 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. Provides direct oversight to Case Managers, meets 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.
- Manage a team of community based Case Managers.
- Promote quality member outcomes to optimize member benefits and to promote effective use of resources.
- Act as a role model to staff and assisting in the day to day activities as needed.
- Ensure care is medically appropriate, high quality, and cost effective.
- Conduct frequent ride-alongs and shadowing of Case Managers for hands on support, quality assurance, and to identify training opportunities.
- Apply clinical knowledge to work with facilities and providers for care-coordination.
- Participate in rounds with the Medical Director.
- Review documentation and processes for consistent practice, and to identify opportunities for growth.
- Initiate and implement process improvements.
- Assist Case Managers in finding solutions to challenging situations and overcoming obstacles to meeting member’s needs.
- Identify and escalate issues appropriately.
- Suggest new approaches to complex problems.
- Ensure all staff achieve the minimal qualification of their position through ongoing staff development, counsel, individual and group education.
- Ensure 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.
- Develop and implement modifications to ensure appropriate distribution of workload in compliance with Delaware Case Manager caseload requirements.
- Recruit, select, orient, evaluate, counsel, and develop performance improvement plans; promote and terminate per corporate policy; and encourage career development and support of staff.
- Adhere to all company, State and Federal requirements related to privacy practices, HIPAA, and quality performance standards.
- Perform other duties as assigned/requested.
- Bachelor's degree in Social Work and 3 years of experience in long-term care, home health, hospice, public health, or assisted living
- Master’s degree in Social Work and 1 year of experience in long-term care, home health, hospice, public health, or assisted living
- Registered Nurse or Licensed Practical Nurse and 2 years of experience in long-term care, home health, hospice, public health, or assisted living
- LTSS experience
- One year of supervisory or managerial experience.
- One year in home clinical or case management experience
- Medicare and Medicaid experience
- Managed care experience
- Leadership skills and be able to relate to all levels of
management and staff as well as individuals external to the corporation
- Leadership, collaboration, and motivational skills
- Ability to multi task and perform in a fast paced, and often intense environment
- Excellent written and verbal communication skills
- Ability to analyze data, measure outcomes and develop action plans
- Team player that possesses strong analytical and organizational skill
- The ability to prioritize work demands and meet deadlines
- Proficiency in PC-based word processing and database documentation (Word, Excel, Internet, Outlook)
- Reliable transportation daily to be able to travel within assigned territory
- Ability to meet regulatory deadlines.
- Has a dedicated home work space used only for business purposes and is able to comply with all telecommuter policies
- Experience in geriatric special needs, behavioral health, home health
- Understanding of the importance of cultural competency in addressing targeted populations.
- Experience with electronic documentation system(s)
- Experience with cost neutrality and budgeting
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.
Referral Bonus: Level 1
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, 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, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
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