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Wellcare

Manager, Long Term Care Clinical Programs*

Wellcare - Chicago, IL

Manager, Long Term Care Clinical Programs*','1703628','!*!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.','!*!The Mgr., LTC Clinical programs position supports the Clinical Director of Managed Long Term Care (MLTC) Program in reaching or exceeding organizational growth targets for the MLTC Program.  Acts as the Clinical Enrollment expert in interpreting Human Resources Administration (HRA) requirements and ensures that all MLTC staff is in compliance with said requirements. 

DEPARTMENT:  Health Services

REPORTS TO: Sr. Director, Field Health Services 

Essential Functions:

Conducts quality reviews of SOE and periodic reassessment SAAMs to ensure personalized plans of care are being developed according to approved medical necessity criteria and WellCare designated criteria along with current clinical knowledge.

Ensures SOE SAAMs are completed correctly and submitted timely to HRA each month.

Ensures that all prospective members are eligible for participation in the Medicare/Medicaid program and that existing members remain eligible.

Refers prospective members, who do not have Medicaid, to the Medicaid Applications team.

Conducts periodic home visit(s) with Clinical Enrollment staff to monitor their knowledge of Program eligibility criteria and benefits and design.

Develops tools to monitor staff productivity and efficiency/efficacy of department policies and procedures.

Identifies opportunities for staff development, e.g., sales training, specific disease management protocols.

Adheres to all HIPPA standards and confidentiality requirements.

Manages MLTC Enrollment Staff.

*LI-Wellcare','!*!Education/Experience:

BSN or relevant Bachelor degree preferred

Candidate Experience:

5 years experience in Case Management, home care, or geriatrics preferred

Licenses and Certifications:

State RN license, no restrictions required.

Case Management Certification (CCM) preferred.

Candidate Skills:

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

Intermediate ability to effectively present information and respond to questions from peers and management.

Intermediate ability to influence internal and external constituents.

Intermediate ability to represent the company with external constituents.

Intermediate ability to work as part of a team.

Intermediate ability to work in a matrixed environment.

Intermediate ability to lead/manage others.

Intermediate demonstrated customer service skills

Intermediate demonstrated interpersonal/verbal communication skills.

Intermediate demonstrated negotiation skills.

Intermediate knowledge of healthcare delivery

Intermediate knowledge of community, state and federal laws and resources.

Computer Skills:

Intermediate or stronger skill level with MS Word, Excel and Outlook required.

Intermediate skill level with healthcare management systems (generic) required.

Languages:

Bilingual preferred','US-IL-Chicago','29 North Wacker Dr','Suite 300','Chicago','60606','','Yes, 20 % of the Time','No','No','Manager, Long Term Care Clinical Programs*'

15 days 12 hours ago

Wellcare

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Manager, Long Term Care Clinical Programs* Wellcare - Chicago, IL, United States

   

Location: Chicago, 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.