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Wellcare

Mgr, Field Care Management RN - Field Case Management - West Palm Beach or Broward*

Wellcare - West Palm Beach, FL

Job Description:

Manages the day-to-day activities of the Field Care Management Team. 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:  Director, Field Care Management

Essential Functions:

Provides ongoing consultation to the care management team 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 and tracks 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 team activities 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 care management team 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:

Candidate Education:

Required An Associate's Degree in Nursing, Health and Human Services or a related field

Preferred A Bachelor's Degree in Nursing or Health Administration

Required Other For Florida Managed Long Term Care program, a Master’s degree in human service, social science or health field plus a minimum of 3 years’ experience in case management is required. OR Bachelor’s degree in human service, social science or health field plus a minimum of 6 years’ experience in case management is required

Required Other For Illinois High Needs Children, a Master's Degree in Nursing, Social Sciences, Social Work or a related field AND a minimum of 3 years supervised experience in the human serviced field is required.

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 year of management experience

Preferred Other NCQA, EQRO accreditation experience

Preferred Other Specialty Experience - In consideration of a specialty program or as a specific discipline leader i.e. Obstetrics, must have at least 5 years of experience or hold a national certification in that area of specialty (in states where applicable)

Required Other For Florida Managed Long Term Care program, 1 years experience in working with the elderly and disabled population and case management experience.

Required Other For Illinois High Needs Children program, a minimum of 3 years of Supervised experience in the Human Services field is required.

Candidate Skills:

Intermediate Ability to communicate 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 communication skills

Intermediate Knowledge of healthcare delivery

Intermediate Ability to multi-task

Intermediate Demonstrated written communication skills

Intermediate Other Abilty to lead and manage others in a metric driven environment

Intermediate Ability to implement process improvements

Intermediate Other Knowledge of medical terminology and/or experience with CPT and ICD 10 coding

Licenses and Certifications:

A license in one of the following is required:

Required Other One of the following licenses is required

Required Licensed Registered Nurse (RN)

Required Licensed Certified Social Worker (LCSW)

Required Licensed Clinical Mental Health Counselor (LCMHC)

Required Other Maintain required contact hours to fulfill regulatory requirements

Preferred Certified Case Manager (CCM)

Required Other For Illinois' High Needs Children, either than RN or any Master's level Behavioral Health clinical licenture is required.

Technical Skills:

Required Intermediate Microsoft Excel

Required Intermediate Microsoft Word

Required Intermediate Microsoft Outlook

Required Intermediate Healthcare Management Systems (Generic)

Languages:

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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 and tracks 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 team activities 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 care management team 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: Candidate Education: Required An Associate's Degree in Nursing, Health and Human Services or a related field

Preferred A Bachelor's Degree in Nursing or Health Administration

Required Other For Florida Managed Long Term Care program, a Master’s degree in human service, social science or health field plus a minimum of 3 years’ experience in case management is required. OR Bachelor’s degree in human service, social science or health field plus a minimum of 6 years’ experience in case management is required

Required Other For Illinois High Needs Children, a Master's Degree in Nursing, Social Sciences, Social Work or a related field AND a minimum of 3 years supervised experience in the human serviced field is required.

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 year of management experience

Preferred Other NCQA, EQRO accreditation experience

Preferred Other Specialty Experience - In consideration of a specialty program or as a specific discipline leader i.e. Obstetrics, must have at least 5 years of experience or hold a national certification in that area of specialty (in states where applicable)

Required Other For Florida Managed Long Term Care program, 1 years experience in working with the elderly and disabled population and case management experience.

Required Other For Illinois High Needs Children program, a minimum of 3 years of Supervised experience in the Human Services field is required.

Candidate Skills: Intermediate Ability to communicate 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 communication skills

Intermediate Knowledge of healthcare delivery

Intermediate Ability to multi-task

Intermediate Demonstrated written communication skills

Intermediate Other Abilty to lead and manage others in a metric driven environment

Intermediate Ability to implement process improvements

Intermediate Other Knowledge of medical terminology and/or experience with CPT and ICD 10 coding

Licenses and Certifications:

A license in one of the following is required: Required Other One of the following licenses is required

Required Licensed Registered Nurse (RN)

Required Licensed Certified Social Worker (LCSW)

Required Licensed Clinical Mental Health Counselor (LCMHC)

Required Other Maintain required contact hours to fulfill regulatory requirements

Preferred Certified Case Manager (CCM)

Required Other For Illinois' High Needs Children, either than RN or any Master's level Behavioral Health clinical licenture is required.

Technical Skills: Required Intermediate Microsoft Excel

Required Intermediate Microsoft Word

Required Intermediate Microsoft Outlook

Required Intermediate Healthcare Management Systems (Generic)

Languages: >

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16 days 15 hours ago

Wellcare

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Please review all application instructions before applying.

Location: West Palm Beach, FL

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.