Supervisor – LTSS Clinical Care Management

Supervisor – LTSS Clinical Care Management

Requirements

• Graduate from an Accredited School of Nursing or a Bachelor’s degree and 4+ years of related experience
• Current state’s Registered Nurse (RN) license Upon Hire required

Responsibilities

• Supervises the care coordination team that serves long-term care members with physical/medical health needs and/or behavioral/mental health needs
• Monitors and reviews long-term care management required documentation to maintain and ensure compliance with federal and state regulations and contractual agreements
• Assigns caseloads and work assignments to long-term care management team based on state requirements, care management staff experience, and member needs
• Works with long-term care senior management on escalated and complex care cases related to physical and/or behavioral health, and provides guidance to junior team members to address member concerns
• 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
• Evaluates long-term care management team performance and provides feedback regarding performance, goals, and career milestones
• Provides coaching and guidance to long-term care management team and providers to ensure members are receiving high quality care and information regarding service / care plan options, procedures, referrals, and healthcare benefits
• Monitors and review reports on a regular basis ensuring quality and productivity metrics are met and for case assignments, and may perform audits of staff on a regular basis
• May perform telephonic, digital, home and/or other site outreach to assess member needs and collaborate with resources
• Assists with onboarding, hiring, and training long-term care management team members
• Leads and champions change within scope of responsibility
• Performs other duties as assigned
• Complies with all policies and standards

Preferred Qualifications

• Highly advanced clinical knowledge and ability to assess member needs in context of relevant diagnoses, treatment plans and goals, and identify potential gaps in care or risks for readmission or complications preferred
• Strong knowledge of healthcare managed care principles preferred
• Experience working with providers and healthcare teams to develop appropriate long-term care plans/service plans preferred
• Strong knowledge of medication indications and side effects and/or knowledge of BH care management principles preferred