Manager – Care Management – Ltss

Manager – Care Management – Ltss

Requirements

• Requires a Bachelor’s degree and 5+ years of related experience.
• Or equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position.

Responsibilities

• Oversees and reviews long-term care management required documentation to maintain compliance with federal and state regulations and contractual agreements.
• Develops, implements, and oversees long-term care management policies and procedures within the long-term care management team based on regulatory requirements and industry standards.
• Assigns, monitors and evaluates work assignments and caseloads of long-term care management staff based on state requirements, care management staff experience, and member needs.
• Directs the daily activities of long-term care management staff including reviewing and approving the caseloads based on state requirements, care management staff experience, and member needs.
• Manages escalated and complex care cases, and provides guidance to long-term care team members to address member concerns.
• Ensure proper coordination and communication of medical service functions with other departmental functions at the business as assigned.
• Develops, implements, and oversees long-term care management programs to facilitate the use of appropriate services and resources.
• Sets goals and objectives for long-term care management team to achieve cost-effective healthcare results.
• Works with long-term care management senior management to provide updates and insights on care management team goals.
• Reviews long-term care member data to identify trends and improve operating performance and quality care in accordance with state and federal regulations.
• Provides coaching and guidance to long-term care management team to improve member and provider experience and facilitate delivery of high-quality care.
• Educates and provides resources for long-term care management team on key initiatives and member outreach to facilitate on-going communication between care management team, members, and providers.
• Assists long-term care management senior leadership with onboarding, hiring, and training long-term care management team members.
• Performs other duties as assigned.
• Complies with all policies and standards.

Preferred Qualifications

No preferred qualifications provided.