Job DetailsJob Location: Smithfield, RI - Smithfield, RI 02917Position Type: Full TimeEducation Level: Bachelors DegreeTravel Percentage: OccasionalJob Shift: DaytimeJob Category: ManagementThis position oversees operational activities of the Care Management area of the Medical Management department. This includes program development and monitoring, staff development including overseeing frontline supervisors. He/she assists in developing and operationalizing new programs and insures regulatory and contractual requirements are met.
Duties and Responsibilities
Responsibilities include, but are not limited to the following:
Develops, executes and evaluates work plan for area of responsibility
Ensures ongoing monitoring, evaluation, and outcome measurement for all Case Management (CM) programs
Provides regular reports and presentations on clinical outcomes of CM programs
Identifies opportunities and cost/benefit for new CM programs and enhancements to existing programs, using data analysis tool
Assists with developing case management programs for new lines of business
Manages CM supervisory staff
Provides supervision, direction and guidance to team while serving as the subject matter expert and lead on functional deliverables
Provides performance feedback and coaching to staff, as well as makes hiring and termination decisions
Assist in the training of new staff and providing an environment of continuous learning for existing staff
Sets performance standards and productivity measures for direct reports
Professional development of staff, including identification of educational opportunities, annual performance appraisals and goal development
Determines/monitors staffing ratios
Develops and ensures consistency in CM documentation standards
Works with Clinical Trainers in the development of comprehensive role specific orientation/training programs
Manages the development of CM policies and procedures and ensures annual review and revision
Collaborates with Chief Medical Officer and Medical Director on new and existing clinical programs
Serves as organizational consultant for CM performance practice
Participates in administrative budget development and monitoring for area of responsibility
Identifies and recommends opportunities for improvement and implements process improvement activities
Representative of CM programs with state and community partners
Collaborates with Matrix partners to develop, maintain and evaluate programs
Other duties as assigned
Corporate Compliance Responsibility - As an essential function, responsible for complying with Neighborhoods Corporate Compliance Program, Standards of Business Conduct, applicable contracts, laws, rules and regulations, policies, and procedures as it applies to individual job duties, the department, and the Company. This position must exercise due diligence to prevent, detect, and report unlawful and/or unethical conduct by fellow co-workers, professional affiliates and/or agents.
Qualifications
Qualifications
Required:
Bachelor degree in health related field or in lieu of Bachelors degree; Associate degree in Nursing with seven (7) years or more in supervisory experience
Active, unrestricted Rhode Island nursing license in good standing. (Consideration will be given to individuals without current RI license. Must provide documentation confirming RI RN application within 24 hours of offer)
Five (5)+ years experience in field of clinical, managed care and/or operational management
Five (5) years supervisory experience
Strong collaboration, interpersonal and leadership skills
Strong oral and written communication skills
Strong analytical skills
Proven ability to develop innovative programs and services
Well-developed organizational and planning skills
Ability to independently problem solve
Intermediate to Advanced skills in Microsoft Office (Word, Excel, PowerPoint, Outlook)
Ability to work extended hours including evenings, nights and weekends
Preferred:
Certification as a Case Manager from an accredited Case Management program
Knowledge of state agencies and community family support resources
Bilingual
Neighborhood Health Plan of Rhode Island is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.
