Manager Case Management Long-term Care - Delaware

📋 Description

• • Lead and manage a team of Case Manager Supervisors, fostering a high-performing environment focused on quality member outcomes and resource optimization.
• • Drive the strategic direction and operational excellence of the case management department, ensuring alignment with organizational goals and regulatory standards.
• • Oversee the development, implementation, and continuous improvement of case management processes, including utilization management, care coordination, and disease management initiatives.
• • Ensure that all case management activities are medically appropriate, high-quality, and cost-effective, directly impacting member well-being and benefit utilization.
• • Accountable for the development and maintenance of departmental policies and procedures, ensuring strict adherence to all state and federal regulations, including NCQA, URAC, CMS, DOH, and DOL standards.
• • Champion a collaborative, interdisciplinary approach to member care, building and maintaining strong relationships with internal departments such as Medical Directors, Behavioral Health, Disease Management, and Utilization Review, as well as external stakeholders.
• • Take ownership of special projects and enhanced activities within the department, contributing to innovation and the expansion of case management services.
• • Ensure comprehensive and accurate reporting to the State of Delaware regarding Long-Term Services and Supports (LTSS) Case Management services, maintaining compliance and transparency.
• • Manage direct reports through effective hiring, training, coaching, counseling, performance evaluation, and development, ensuring a skilled and motivated team.
• • Plan, organize, direct, and control the day-to-day operations of the department, potentially managing budgetary responsibilities and authority to achieve departmental objectives.
• • Monitor and track the completion of assigned work by direct reports, ensuring productivity and adherence to performance metrics.
• • Provide essential service support, coordinate training, and manage performance metrics and statistics for the team, while actively initiating and implementing process improvements.
• • Assist direct reports in problem-solving escalated issues and identify opportunities for appropriate escalation to higher management or other departments.
• • Organize and facilitate regular staff meetings to ensure effective corporate and operational communication, supported by meeting minutes, and to provide an open forum for issue resolution and problem-solving.
• • Encourage innovative thinking and suggest new approaches to address complex challenges within case management.
• • Set clear performance targets, measure outcomes against these targets, and establish strategic plans to address any variances in quality, staff retention, financial performance, and customer satisfaction.
• • Ensure all staff members achieve and maintain the minimal qualifications for their positions through ongoing staff development, counseling, and both individual and group education.
• • Oversee and coordinate all departmental activities, including staff education, policy and procedure development and revision, and individual staff audits to ensure adherence to best practices and regulatory requirements.
• • Ensure overall departmental operations comply with all established standards and regulations.
• • Recruit, select, orient, evaluate, counsel, and develop performance improvement plans for all direct reports, fostering a culture of continuous growth and accountability.
• • Promote staff development and support, encouraging career advancement and retention within the team, and manage disciplinary actions, including termination, in accordance with corporate policy.
• • Develop and implement appropriate audit requirements to ensure staff activity related to Case Management is compliant with all regulations and internal policies.
• • Maintain consistent and open lines of communication with both internal and external customers, ensuring a high level of service and engagement.
• • Effectively communicate changes in processes and programs to the team and stakeholders, reinforcing a shared vision and mission for the department.
• • Clearly communicate outcomes, data analysis, complex processes, and action plans to division/unit staff, corporate partners, and external customers, ensuring understanding and buy-in.
• • Facilitate and lead informational and educational meetings for internal and external customers, serving as a subject matter expert and educator.
• • Coordinate, develop, and implement departmental and divisional projects, contributing to the strategic growth and improvement of Highmark Health's services.
• • Uphold the highest ethical and legal standards, adhering to the company's Code of Business Conduct, privacy policies, and data security guidelines, including HIPAA.
• • Ensure the accessibility of services and application processes for all individuals, in accordance with company policy and legal requirements.