JOB SUMMARY:Under the direction of the Manager of Medicaid and Exchange:|
Provides professional oversight, leadership and guidance over the day-to-day operation of the Acute Case and Condition Health Management Team. Responsible for clinical operations and medical management activities across the continuum of care (assessing, planning, implementing, coordinating, monitoring and evaluating). Ensures the development, implementation, coordination, and evaluation of case management based activities and interventions. Oversees the performance of internal Case Management programs and the interaction with community-based resources. Designs and maintains processes and workflows to support case management programs and coordination with other interfaces as relevant. Interviews, screens and recommends for hire, orients, evaluates, and counsels staff. Resolves complex issues with staff. Prepares and reviews regular reports on Case and Condition Health Management activity; prepares and presents cases to the Manager and Associate Director. Receives and analyzes performance reports, creating action plans as required. Knows and interprets MVP contracts, policies and procedures. Acts as a liaison between the case and condition health management teams and the strategic business units (SBUs), internal staff, Medical Directors, community partners and other MVP service providers. Interacts with other departments to define data requests, test system performance and evaluates process improvement opportunities. Interacts with Member services, Provider Relations, Quality Improvement, and Finance to identify utilization trends. Performs other duties as assigned.
" Registered Nurse and/or Licensed Social Worker is required. Bachelor s degree in Nursing or Health Management Administration preferred
" Case Management Certification preferred or must be obtained within 2 years of hire date
" Prior supervisory or Team Lead experience in a managed care setting is required
" Three years recent case and or disease management experience is required
" One year of UM experience is preferred
" Strong interpersonal and communication skills required. Independent thought process; oriented toward probing and problem solving w/ working knowledge of computer software applications;
" Computer literacy required (Microsoft office skills). Ability to navigate multiple computer systems concurrently required.
" Proven success with interacting with providers and physicians on delicate matters required.
" Excellent written and verbal communication skills.
" Ability to exercise discretion in handling confidential member information
" Ability to supervise and train on site and e-worker staff, including organizing, prioritizing, and scheduling work assignments required and travel to regional offices.
MVP Health Plan covers about 650,000 most valuable people. Also known as MVP Health Care, the company provides health insurance and employee...