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Wellcare

Manager, Field Case Management-RN*

Wellcare - Springfield, IL

Manager, Field Case Management-RN*','1703648','!*!About WellCare: WellCare Health Plans, Inc. is a Fortune 500 company traded on the New York Stock Exchange (symbol: WCG). It provides managed care services targeted to government-sponsored health care programs, including Medicaid, Medicare, Prescription Drug Plans and the Health Insurance Marketplace. Headquartered in Tampa, Fla., WellCare offers a variety of health plans for families, children, and the aged, blind and disabled. The company serves approximately 4 million members and employs approximately 6,500 people nationwide as of Sept. 30, 2014. For more information about WellCare, please visit our website at www.wellcare.com or view our videos at https://www.youtube.com/user/WellCareHealthPlan.EOE: All qualified applicants shall receive consideration for employment without regard to race, color, religion, sex, age forty (40) and over, disability, veteran status, or national origin.','!*!Manages the day-to-day activities of the Field Service Coordinators (Field Case Managers) and Supervisors. Ensures the case management process of assessing, planning, implementation, coordination, monitoring, and evaluating services and outcomes is pursued to maximize the health of the Member. Promotes effective healthcare utilization, monitors health care resources and assumes a leadership role within the Interdisciplinary Care Team (ICT) to achieve optimal clinical and resource outcomes for member. Oversees the socio economic needs and services of selected member populations across the continuum of illness. Provides ongoing support and oversight to staff.

DEPARTMENT:  Health Services

REPORTS TO:  Sr. Director, Field Health ServicesEssential Functions:

Provides ongoing consultation to Field Service Coordinators and reviews caseloads on an ongoing basis, both through regular face-to-face supervision sessions and review of management reports and deadlines.

Assists Medical Director and Dir, Field Service Coordination in creating department goals, objectives and metrics.

Oversees the implementation of programs and strategies.

Develops and implements case management workflows and policies & procedures.

Proactively monitors appropriate metrics to drive up efficiency.

Perform audits of assessments, care plans and service notes to verify cases are properly established and that member coordination activities are occurring and appropriately documented.

Coordinates activities of unit to meet contractual company deadlines and resolves interpersonal conflicts.

Partners & collaborates with other departments cross functionally regarding care and case management and/or Health Service initiatives.

Directs work assignments, measures results and initiates personnel actions as required.

Develops, implements and manages process improvement initiatives.

Monitors associate performance and conducts counseling/corrective action procedures when required. Identifies concerns, brings issues to management’s attention and offers suggestions for improvement.

Reviews time records, sets schedules and approves all vacation/time off requests for subordinate associates.

Provides training and guidance to new and current Field Service Coordinators regarding policy & procedure, systemic tools, workload and care/case plan development.

Answers all questions and assists peers and management with delegated tasks or projects.

Ensures compliance with all state and federal regulations as well as Corporate guidelines in day-to-day activities.

Performs special projects as needed.

Additional Responsibilities:

Will travel within state as needed to manage remote staff.

*LI-Wellcare','!*! Candidate Education:

Required minimum Associate's degree in Nursing (RN); Bachelor's degree is preferred (RN).

Candidate Experience:

Required 5 years of experience in case management, clinical acute care, home health, hospice, physician's office or public health.

Required 3 years of experience in managed care.

Required 1 years of people management experience.

Preferred, NCQA, EQRO accreditation experience; Specialty Experience - inconsideration of a specialty program or as a specific discipline leader, i.e. Obstetrics, must have at least 5 years of experience of hold a national certification in that area of specialty in states where applicable.

Licenses and Certifications:

Required Registered Nurse (RN) in state of practice, with no restrictions.

Required to maintain required contact hours to fulfill regulatory requirements.

Preferred Certified Case Manager (CCM); Specialty Experience- national certification in that area of specialty in state where applicable.

Candidate Skills:

Intermediate ability to communication and make recommendations to upper management

Intermediate demonstrated time management and priority setting skills.

Intermediate ability to lead/manage others

Intermediate ability to create, review and interpret treatment plans.

Intermediate demonstrated negotiation skills.

Intermediate demonstrated problem solving skills.

Intermediate demonstrated interpersonal/verbal communication skills.

Intermediate knowledge of community, state and federal laws and resources

Intermediate ability to effectively present information and respond to questions from families, members and providers

Intermediate demonstrated written and verbal communication skills.

Intermediate knowledge of healthcare delivery.

Intermediate ability to multi-task.

Intermediate ability to lead and manage others in a metric driven environment.

Intermediate ability to implement process improvements.

Intermediate knowledge of medical terminology and/or experience with CPT and ICD9/10 coding.

Technical Skills:

Required intermediate skill level or stronger with MS Excel, Word, Outlook.

Required intermediate skill level with generic Healthcare Management Systems.

Languages:

Bilingual helpful.','US-IL-Springfield','','','Springfield','62701','','Yes, 50 % of the Time','No','No','Manager, Field Case Management-RN*'

8 days 18 hours ago

Wellcare

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Manager, Field Case Management-RN* Wellcare - Springfield, IL, United States

   

Location: Springfield, IL

Company Profile:
WellCare Health Plans, Inc. focuses exclusively on providing government-sponsored managed care services, primarily through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans, to families, children, seniors and individuals with complex medical needs. The company served approximately 3.8 million members nationwide as of Sept. 30, 2015. For more information about WellCare, please review our website and view the company’s videos. WellCare has developed a full complement of expertise in three major areas of government-sponsored health care…. Medicaid, Medicare Advantage and Medicare Prescription Drug Plans. Leveraging our expertise for our members' benefit is a key part of the value we bring to our members. WellCare focuses on those members who are dually eligible for both Medicaid and Medicare. This is an area of specialization that many other health plans simply do not have. We are committed to continually improving the quality of care and service that we provide to our members. We help our members access the right care at the right time in the appropriate setting. For some members, this includes the use of coordinated care teams and community partnerships. And we’re focused on government customers and use a disciplined approach to ensure a competitive cost structure.