REGISTERED NURSE- Supervisor Integrated Care Management (SIGN ON

REGISTERED NURSE- Supervisor Integrated Care Management (SIGN ON

For immediate consideration send resume to tdwilliams(at)amerihealthcaritas.com or hr(at)hoosieralliance.org Under the supervision of Senior Manager Care Coordination the Supervisor Care Coordination is responsible to provide daily oversight of the care coordination unit and provide clinical direction organization and monitoring of all Care Coordination services. Responsible for direct supervisory oversight of the staff that are conducting case management screening care coordination case management and other supportive functions. Assists in carrying out the plans and daily operations of the Care Coordination unit(s). Knowledgeable in workflow productivity and timelines standards for all disciplines providing services within Care Coordination Unit. Provides Unit and Departmental leadership. Ensures that staff receive appropriate orientation and training to organizational and departmental policies and procedures and ensures that staff have the clinical expertise to perform assigned duties. Maintains a current knowledge of KMHP Policies and Procedures DPW requirements NCQA standards and recommendations impacting care assessment access and delivery in Care Coordination department including but not limited to conducting telephonic case management screening appropriate communication with members case management disease management prior authorization inpatient review discharge planning home health and SNF Rehabilitation services. Provides clinical oversight and coordination of KMHP programs in accordance with applicable statutory provisions and complies with URAC NCQA and DPW requirements Health Choices contract and established policies and administrative procedures. Monitors staff work assignments and makes appropriate adjustments based on staff experience severity of cases and type of intervention(s) required. Provides coaching and counseling to improve productivity within the scope of HR policies and procedures. Functions as a member of the interview team in assessing candidates and ensures that minimal qualifications are met. Participates in training and education of new and existing staff. Works collaboratively with the Manager to prepare reports and conduct analysis of operations services as required by departmental corporate and or regulatory requirements. Performs quality audits per KMHP policy for assigned staff. Shares audit results with associates and provides necessary education and counseling to improve performance. Completes annual performance evaluations of all assigned staff. Completes evaluations using objective and measurable performance measures. Completes evaluations on time. Develops implements and monitors associates placed on performance improvement plans under the direction of the Sr Manager. Participates in current process review and development of new and or revised work processes policies and procedures relating to Care Coordination responsibilities. Provides input into the development of educational materials and programs necessary to meet KMHP business objectives member s needs and regulatory guidelines and staff professional development. Acts as a liaison for KMHP with outsides entities including but not limited to physicians hospitals health care vendors social service agencies member advocates regulatory agencies. Creates and supports an environment which fosters teamwork cooperation respect and diversity. Establishes and maintains positive communication and professional demeanor with KMHP employee and members at all times. Demonstrates and supports commitment to corporate goals and objectives. Complies with Corporate Federal and State confidentiality standards to ensure the appropriate protection of member identifiable health information. Maintains all necessary educational requirements for required licensure and certifications. Performs other related duties and projects as assigned. Position Qualifications Requirements Individuals who supervise case management practices must have at least one of the following qualifications Education and Training A bachelors (or higher) degree in a health related field and licensure as a health professional (where such licensure is available) or Certification as a case manager (as documented and accepted on URAC s website(at) www.urac.org) or Professional certification in a clinical speciality and at least three (3) years experience as a case manager and If they have directly supervised the case management process for three or more years hold a certification as a case manager. Licenses Registrations or Certification Valid driver s license with car insurance Current unrestricted Registered Nurse License in Washington DC Other Certification as a Case Manager (as accepted by URAC) required within 1 year of accepting position. Three five years of Case Management