Note: The job is a remote job and is open to candidates in USA. Highmark Inc. is a healthcare company seeking a Supervisor for Case Management in Pennsylvania. The role involves managing a team of clinicians to promote quality member outcomes and optimize member benefits while ensuring compliance with various regulations.

Responsibilities

Manage and coordinate all department activities; staff education, policy and procedure development and revision, individual staff audits, oversees overall operations to ensure compliance to standards
Ensure appropriate distribution of workload; monitors/tracks staff completion of assigned work
Develop and implement modifications needed, to workload plan, to ensure completion and appropriately coach/counsel staff
Act as a role model to staff and be able to assist in the day to day activities as needed
Provide service support, training and performance metrics/statistics, to the team, in addition to initiating and implementing process improvements
Recruit, select, orient, evaluate, counsel, and develop performance improvement plans; promote and terminate per corporate policy; and encourage career development and support of staff
Identify and escalate issues appropriately
Apply clinical knowledge to work with facilities and providers for care-coordination
Plan for and conduct staff meetings that assure corporate and operational communication supported by meeting minutes; and provide an open forum for issues and problem solving
Suggest new approaches to complex problems
Appropriate targets, measure outcomes and establish plan to negate variances in quality, staff retention, finance and customer satisfaction
Provide direct reports with guidance and educational tools in order to ensure compliance with NCQA, URAC, DOH, DOL and CMS
Review and provide input into the oversight of policies and procedures to support regulatory requirements related to Case Management
Develop and implement appropriate audit requirements in order to ensure compliance with all staff activity related to Case Management
Ensure that all staff achieves the minimal qualification of their position through ongoing staff development, counsel and motivate employees, evaluate employees, investigate complaints or performance concerns; implement disciplinary action as needed and in consultation with appropriate authority and Employee Relations
Display effective communication skills
Maintain consistent and open lines of communication with internal and external customers
Communicate changes in processes and programs in order to enhance a share vision and mission
Effectively communicate outcomes, data analysis, complex processes and action plans to division/unit staff, corporate partners, and external customers
Facilitate and lead informational and educational meetings for internal and external customers
Accountable for special projects and enhanced activities within the department
Participate in the development and implementation of department/division projects
Implement integration processes and planning activities
Other duties as assigned or requested

Skills

High School Diploma or GED
Current license in one or more of the following disciplines LCSW, LSW, LPC, or other related clinical license (OR) Current State RN licensure OR Current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC)
5-7 years of clinical experience
3-5 years of experience in case management/managed care
CHW (Community Health Worker Cert.) Must obtain within a year of being hired
Bachelor's degree

Company Overview

Highmark provides health insurance plans for individuals and businesses. It was founded in 1996, and is headquartered in Pittsburgh, Pennsylvania, USA, with a workforce of 10001+ employees. Its website is https://www.highmark.com.

Highmark

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