Manager, LTSS Service Determination Operations

Job description

Job Summary: The Manager, Complex Health - Clinical is responsible for providing operational management and oversight to Care Coordinators, Clinical Care Managers and Service Determination employees dedicated to the Complex Health Clinical program. Individuals participating in the program are highly complex with diverse clinical needs. The Complex Health Clinical program considers the whole person as a collective and ensures the correct services are coordinated, approved and delivered with the highest quality. Essential Functions: Responsible for successful day to day operation of the Complex Health Clinical program Oversees a team of clinical and nonclinical staff to achieve quality service level and production expectations Manages and evaluates team member performance; provides coaching, counseling, employee development, and recognition; ensures ongoing, appropriate staff training; and has responsibility for the selection, orientation, and mentoring of new staff Maintains professional relationships with provider community, internal and external customers, and state agencies as appropriate, while identifying opportunities for improvement Utilizes available tools / platforms for efficiencies Ensures adequate staffing and service levels and maintains customer satisfaction by implementing and monitoring staff productivity and other performance indicators Ensures completion of staff quality audit reviews; evaluates services provided and outcomes achieved and recommends enhancements/improvements for programs and staff development to ensure consistent cost effectiveness and compliance with all state and federal regulations and guidelines Facilitate/promote problem identification, analysis, and resolution to improve member experience ensuring compliance with state and federal regulatory and accrediting standards Collaborate with Clinical Operations business owners to ensure members are getting the clinical care they require and that process are efficient and effective Collaborate with Analytics/IT when data is necessary for operations performance Review detailed reports to inform team performance Follow and teach Care Coordination, Service Determination and Utilization Management teams the CMS, State government regulations and NCQA requirements to ensure compliance Assist with the continuous improvement of Complex Health Clinical program best practices, processes, and tools Perform any other job duties as requested Education and Experience: Master’s degree in a Human Service Field is required Five (5) years of post-degree professional experience is preferred Minimum of two (2) years of supervisory experience is required Two years’ Care Coordination and/or Case Management and/or Utilization Review/Management experience preferred Experience with MH/IDD waivers preferred Competencies, Knowledge and Skills: Excellent proficiency with Microsoft Office tools, including Project, Word, PowerPoint, Excel, Visio, Teams, Outlook, etc. Demonstrates analysis and reporting skills Excellent decision making/problem solving skills Exceptional interpersonal and relationship building skills Excellent critical listening and thinking skills Proven ability to effectively interact with all levels of the organization of management within and externally to the organization Excellent written and verbal communication skills Customer service oriented Proven ability to prioritize work and team assignments to deliver projects on time, on budget, and meeting stakeholders expectations Demonstrates a sense of urgency Basic knowledge of healthcare data coding such as CPT, HCPCS, ICD10, DRG and Revenue codes preferred. Strong experience in the Complex Population healthcare payer industry and knowledge of Medicaid and Medicare Experience operating HCBS/(b)(c) and (i) waivers preferred Licensure and Certification: Valid licensure in the profession (social work, counseling or psychology) is required Valid licensure or certification in Substance Use preferred Working Conditions: General office environment; may be required to sit or stand for extended periods of time Some Travel to meet the needs of the market and product Compensation Range: $74,700.00 - $119,520.00 CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package. Compensation Type (hourly/salary): Salary Organization Level Competencies Fostering a Collaborative Workplace Culture Cultivate Partnerships Develop Self and Others Drive Execution Influence Others Pursue Personal Excellence Understand the Business This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds. #LI-JS1 Brand=CareSource