Medical Management Supervisor

US-RI-Smithfield
Req No.
2017-7380
Department
Medical Mgmt Care Mgmt
Type
Regular Full-Time
Category
Medical/Health

Overview

Provides oversight for specific care management or medical review programs/activities and works collaboratively with the Health Care Team to manage and coordinate care in order to ensure quality and cost-effective patient-centered care. He/she supervises a team and ensures delegated work is timely, accurate and delivered on schedule.

Responsibilities

  • Engage in on-going performance management of staff including coaching, mentoring, development, training and succession planning to include hiring and termination decisions
  • Serves as the subject matter expert and lead on functional deliverables ensuring optimal efficiency in area of responsibility
  • Ensure comprehensive training that may include supervising home visits
  • Oversee and coordinate day-to-day operational activities including daily assignments, coverage issues
  • Assist in settings performance standards and productivity measures
  • Monitor program statistics, compliance and adherence to performance standards
  • Assist manager with development and design of new programs
  • Provide direct oversight and serve as a clinical resource to the team in making case management care coordination and appropriateness of care recommendations/decisions
  • Monitor clinical outcomes and assist manager in evaluating outcomes
  • Recommend opportunities for improvement in care coordination operational processes
  • Assist manager in development and revision of specific policies and protocols, operational issues, staffing, resources, system and program needs
  • Serve as primary contact at Neighborhood for providers, families and other community resources
  • Serve as liaison to community resources
  • Represent department on committees and in external marketing and education presentations
  • Participate and assist with performance measures, quality improvement activities and regulatory requirements
  • Take responsibility for own professional development and competency requirements
  • Other duties as assigned
  • Corporate Compliance Responsibility - As an essential function, responsible for complying with Neighborhood’s Corporate Compliance Program, Standards of Business Conduct, applicable contracts, laws, rules and regulations, policies and procedures as it applies to individual job duties, the department, and  the Company. This position must exercise due diligence to prevent, detect and report unlawful and/or unethical conduct by fellow co-workers, professional affiliates and/or agents

Qualifications

Required:

  • Bachelor’s degree and/or sufficient work experience to equate to the degree in related field
  • Registered Nurse with an active, current, unrestricted license in Rhode Island in good standing or Licensed Independent Clinical Social Worker (LICSW)
  • Three (3)+ years managed health care experience or related field
  • Five (5) years of managed health care or related experience
  • Two (2) years supervisory experience
  • Broad clinical experience with special needs and chronic medical conditions   
  • Medical care management experience                                                                                                                                  
  • Knowledge of medical, behavioral health and social services systems of care for individuals with special health care needs including disease management principles               
  • Intermediate to Advanced skills in Microsoft Office (Word, Excel, PowerPoint, Outlook)
  • Strong organizational and documentation skills with the ability to manage multiple priorities
  • Strong consumer advocacy skills    
  • Demonstrated ability to communicate, problem solve and work effectively with people                                         
  • Demonstrated ability to effectively prioritize and execute tasks in a high-pressure environment and meet contractual timelines
  • Strong communication skills (written/verbal)
  • Good working knowledge of regulatory requirements/standards
  • Must exhibit a high level of professionalism and integrity
  • Adherence to all confidentiality regulations and agreements
  • Flexibility to work some evening hours

Preferred:

  • Case management certification
  • Behavioral health care management experience
  • Clinical experience
  • Medicaid and/or Medicare knowledge/experience
  • Bilingual (English/Spanish) 

Neighborhood is an Affirmative Action and Equal Opportunity Employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, national origin, genetic information, age, disability, veteran status or any other legally protected basis.

 

Neighborhood is committed to ensuring individuals with disabilities and/or those who have special needs participate in the workforce and are afforded equal opportunity to apply for jobs. If you would like to contact us regarding the accessibility of our Website or need assistance completing the application process, please contact us at recruiting@nhpri.org

 

Neighborhood is an EOE M/F/D/V and an E-Verify Employer

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