Manager, Care Management - LTSS/RN - Remote

Summary of Job

Responsible for the day-to-day operation and performance of the care management team providing care management services to EmblemHealth members. Utilize data to monitor team member performance (quality, outcome and productivity measures, etc.); deploy strategies to improve performance. Provide coaching and mentoring to team members to address performance related issues. Use problem solving abilities to create solutions to operational and clinical issues identified during day-to-day operations. Collaborate with the Director and AVP of Care Management and internal audit teams to address audit related findings and implement performance improvement strategies. Develop job aides, work flows and other tools to enhance delivery of care management services. Collaborate with other functional areas within organization to ensure that Care Managers are implementing EmblemHealth Health Plans policies, procedures and all regulatory mandates, consistent with Emblem Health Plans mission, vision, purpose
and value statement.

Responsibilities

• Manage daily operations of the Care Management team including measurement of performance metrics and productivity standards; implement, deploy, and reinforce strategies to improve performance.
• Train employees in process operations; act as a preceptor to newly hired staff.
• Complete quarterly evaluations of staff as needed.
• Monitor team caseloads; shift workloads accordingly to meet departmental/organizational needs.
• Monitor timeliness and appropriateness of documentation in clinical systems to ensure that documentation meets accreditation and regulatory standards.
• Ensure that team members are managing enrollees across the care continuum, inclusive of behavioral health, so that enrollees have access to needed care and services.
• Serve as a clinical resource; attend Care Management rounds.
• Monitor employees' performance regularly and coach employees as needed.
• Perform other related tasks as directed or required.