Note: The job is a remote job and is open to candidates in USA. Highmark Inc. is a healthcare company seeking a Supervisor Case Management to manage a team of clinicians focused on promoting quality member outcomes and optimizing member benefits. The role involves overseeing case management processes, ensuring compliance with regulations, and developing staff through training and performance evaluations.
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
- Data analytics experience
- Customer Service is preferred
- Supervisory experience
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.
