• Delegated Entity Oversight Supervisor - Case Management

    Job Locations US-RI-Smithfield
    Req No.
    2018-9792
    Department
    Case Management
    Type
    Regular Full-Time
  • Overview

    This position requires an individual with strong leadership, communication and analytical skills. He/she will be the liaison between various departments and external community case management entities. This position will participate in all oversight audits of these case management agencies. He/she will be a liaison to these contracted agencies, review their productivity reports and ensure accurate entry into the company’s Acuity system. He/she will also be responsible for the ongoing education and monitoring of the agencies’ compliance with EOHHS, CMS and contractual requirements for day-to-day functions. He/she will also oversee internal staff that are coordinating and approving special LTSS programs. This position requires a wide degree of creativity and latitude. 

    Responsibilities

    • Serves as the subject matter expert and lead on functional deliverables ensuring optimal efficiency in area of responsibility
    • Oversight, monitoring and training case management (CM) agencies to ensure that contracted case management agencies understand their contractual responsibilities and adhere as appropriate
    • Identifies key metrics, prepares reports and presentations for EHHOS, CMS, senior leadership and external stakeholders.
    • Collaborates with other departments to provide clinical input for audits and development of corrective action plans
    • Participates in audits to provide clinical perspective, CM documentation and activity requirements
    • Assists in the aggregation and analysis of audit findings
    • Coordinates special projects and initiatives
    • Develops data tracking mechanisms and reports for multiple deliverables
    • Serves as a liaison to both internal and external partners
    • Provides clinical input into oversight of department related contracts. Works with the company’s Provider Engagement and Contracting department to ensure, from a clinical perspective, that the agencies are adhering to their scope of work
    • Assist in writing and editing scopes of work for requirements contracts
    • Facilitates meetings with CM agencies, develops and delivers progress reports, proposals, requirements, presentations and other documentation
    • Participates in community stakeholder meetings
    • Supports the department’s leadership team for operational work as well as larger scope activities, including writing department annual reports and ad hoc requests, develops and maintains department dashboards and performs department audits of a non-clinical nature
    • Engage in on-going performance management of staff including coaching, mentoring, development, training and succession planning to include hiring and termination decisions
    • Participates in RHO Quality Improvement committee and activities and provides reports
    • 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 and/or years of experience and background to equate to the degree
    • Registered Nurse (RN) or Licensed Independent Clinical Social Worker (LICSW), active, current, unrestricted license in Rhode Island in good standing
    • Two (2)+ years’ experience in an HMO or long-term care support services setting
    • One (1)+ years of health related project management experience
    • Two (2) years of direct/indirect supervisory experience
    • An understanding of medical management data relationships
    • Strong communication skills (written and verbal)
    • Excellent presentation skills particularly with educating and training large audiences
    • Excellent interpersonal skills, including the ability to work across the organization and to interact, influence and negotiate effectively at all levels of management
    • Demonstrated ability to manage multiple activities simultaneously in a deadline drive environment
    • Confident team builder and leader with strong motivational skills
    • Adept in problem solving and resolving conflict
    • Intermediate to Advanced skills in Microsoft Office (Project, Word, Excel, PowerPoint, Outlook)
    • Demonstrated ability to establish detailed project plans with accurate resource and time estimates
    • Must have outstanding time management and organizational skills


    Preferred:

    • Clinical experience
    • Working knowledge of the company’s software system, Acuity

    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

    Options

    Sorry the Share function is not working properly at this moment. Please refresh the page and try again later.
    Share on your newsfeed

    Need help finding the right job?

    We can recommend jobs specifically for you! Click here to get started.