Manager of Care Management

It's an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.

Job Summary

The Manager of Care Management is responsible for managing the day-to-day operation of the Care Management teams including hiring, scheduling, coaching, development and evaluation of employee performance. Positions reporting to the manager include, Nurse Care Clinicians, Social Workers, Community Health Workers and Care Navigators. The manager will develop, monitor and revise workflow operations to ensure team and department efficiency and will analyze available data to measure individual and team performance, and department. Working with his or her staff, the manager will recommend and assist in the development and implementation of policies and procedures that integrate state, federal and national accreditation regulations to ensure compliance. The manager will oversee the training of the staff and work collaboratively with the clinical trainer to develop team and individual staff level orientation, skill building and educational programs for the team and the department. The manager will actively participate as a member and / or lead on internal departmental, divisional and or corporate committees and in conjunction with the Senior Manager of Care Management and the Director of Care Management will assume responsibility for critical tasks including the management of one or more focused clinical initiatives.

Our Investment in You:

• Full-time remote work
• Competitive salaries
• Excellent benefits

Key Functions/Responsibilities:

• Directs and manages all operational and management activities of the Care Management teams including the development and implementation of effective metrics to monitor productivity, development of workflows and job aids and management of clinical and non-clinical staff as well as facilitation of team meetings.
• Directs the distribution of work among assigned staff and ensures members with most actionable interventions are assigned for outreach and engagement.
• Utilizes operational reports to ensure individual, team and department metrics are met and makes operational corrections as necessary. Monitors changes for improved outcomes.
• Monitors staff performance on a regular basis through audits, operational reports and metrics and provides timely feedback and implements corrective actions plans as needed.
• Conducts weekly team meetings, clinical rounds, and 1-1 mentoring of all staff
• Identifies areas for improvement of existing operational policies and procedures and develops recommendations for the Director of Care Management.
• Hires staff for allocated positions
• Oversees the analysis, development, implementation and evaluation of the care management program and policies so that quality, documentation, policies and procedures are consistent with current federal and state regulations and applicable accreditation standards (e.g. NCQA)
• Works closely with all appropriate internal departments and community based organizations/partners o resolve complex issues related to the medical and social case management of members. Acts as a liaison to the Legal Compliance and Quality Departments
• Other functions as required to support departmental activities

Supervision Exercised

* Manages 10-15 clinical and non-clinical staff

Supervision Received

* Regularly schedule meetings with Director of Care Management

Qualifications

Education Required:

* Bachelor's degree in nursing or Associate's degree in Nursing and relevant work experience or

• Master's Degree in Social Work or equivalent relevant work experience.

Education Preferred:

* CCM certification

* Bachelors or Master's Degree in Nursing or related field

Experience Required:

* 3 years prior management experience.

* 10 years clinical experience including acute care and care management or discharge planning in an acute care or health insurance environment or home care.

Experience Preferred/Desirable:

* Experience with Medicaid recipients and community services.

* Experience with electronic healthcare applications

Required Licensure, Certification or Conditions of Employment:

* Current state licensure as a Registered Nurse

* Certification in Case Management Preferred

Competencies, Skills, and Attributes:

* Understands health care delivery to diverse patient populations

* Demonstrated commitment to excellent customer service

* Intermediate skill level with Microsoft Word, Excel, Visio and PowerPoint.

* Effective collaborative and proven process improvement skills

* Strong oral and written communication skills; ability to interact within all levels of the organization as well as with external contacts

Working Conditions and Physical Effort

* Fast paced office environment.

* Work is normally performed in a Home/office work environment.

* No or very limited physical effort required. No or very limited exposure to physical risk.

About WellSense

WellSense Health Plan is a nonprofit health insurance company serving more than 440,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded 25 years ago, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances. WellSense is committed to the diversity and inclusion of staff and their members.

Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status. WellSense participates in the E-Verify program to electronically verify the employment eligibility of newly hired employees