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.
