Medicaid Care Manager Team Lead (RN)

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Pulivarthi Group LLC is a Global Staffing & IT Technology Solutions company, with our prime focus of providing world class solutions to our customers with the right talent. We combine the expertise of our team and the culture of your company to help you with the solution that is affordable and innovative using high quality standards and technologies.

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Position Overview

Under the direction of the Director of Medicaid, the Medicaid Care Manager Team Lead ensures that staff adhere to the Medicaid contractual requirements, policies and procedures, and workflows established to manage the vulnerable Medicaid population. The Medicaid Care Manager Team Lead manages the daily activities of the Medicaid team (Care Managers and Care Management Associates) to ensure quality outcomes in the delivery of member-centered case management including reduction in emergency room visits and hospital admissions, improved member satisfaction, improved member health, and cost effectiveness.

Job Description

• Provide clinical guidance and supervision to assigned Care Managers and clinical support staff to promote efficient and effective delivery of care management services.
• Supervise day to day activities to make certain that case management services are provided in accordance with clinical guidelines, established processed and MetroPlusHealth organizational standards.
• Supervise the entire care management workflow including case referrals, assignments, interventions and goal setting, follow-up/follow-through activities, documentations, and escalations.
• Ensure care management activities are conducted in a safe, efficient, and effective manner to promote continuity and quality of care.
• Review, develop and modify day to day workflows to ensure timely follow up.
• Perform ongoing quality review of cases to ensure accuracy and compliance.
• Evaluate and document staff performance; coach staff to improve both quality and quantity of skills attaining optimal performances.
• Utilize data to track, trend and report productivity and outcome measures, work with the management team to implement necessary improvement strategies.
• Coordinate Interdisciplinary Care Team rounds with providers, care managers and care management associates, this include scheduling meetings, identifying members for presentation, and ensuring completion and documentation of follow up activities.
• Collaborate Behavioral Health to develop strategies and best practices that lead to desired goals and objectives for members who are co-managed.
• Use expert verbal and non-verbal communication skills to motivate and gain co-operation of members and their caregivers.
• Resolve issues and mitigate conflict encountered during daily operations, appropriately escalate issues to the Director of Medicaid
• Identify and report potential risk, operational opportunities, and barriers encountered
• Conduct monthly audits for the purpose of departmental/organizational reporting and providing formal feedback to case management staff.
• Create and submit operational weekly/monthly/quarterly reports.
• Work with the leadership team to develop and implement ongoing training and development efforts.
• Actively participate in staff training and meetings.
• Encourage regular communication and inform staff of relevant departmental and organizational updates.
• Develop and maintain collaborative relationships with clinical providers, facility staff and community resources.
• Ensure staff comply with orientation requirements, annual and other mandatory trainings, organizational and departmental policies, and procedures.
• Perform other duties as assigned by Director.
  
  

Minimum Qualifications

• Bachelor’s Degree required, Master’s preferred.
• A minimum of 5 years of Care Management experience in a health care and/or Managed Care setting required.
• Minimum of 2 years managerial/leadership experience in a Managed Care and/or healthcare setting required.
• Proficiency with computers navigating in multiple systems and web-based applications. x Must know how to use Microsoft Office applications including Word, Excel, and PowerPoint and Outlook.
• Ability to proficiently read and interpret medical records, claims data, pharmacy and lab reports, and prescriptions required.
• Ability to travel within the MetroPlusHealth service area making home visits to members, facility visits to clinical providers, and visits to community, faith, and other social service-based agencies.
  
  

Licensure And/or Certification Required

• Registered Nurse with a current New York State License.
  
  

Professional Competencies

• Integrity and Trust
• Customer Focus
• Functional/Technical Skills
• Confident, autonomous, solution driven, detail oriented, nonjudgmental, diplomatic, resourceful, intuitive, dedicated, resilient and proactive.
• Strong verbal and written communication skills including motivational coaching, influencing, and negotiation abilities.
• Holds themselves to high standards of excellence.
• Time management and organizational skills.
• Strong problem-solving skills.
• Ability to prioritize and manage changing priorities under pressure.
• Ability to work closely with member and caregiver.
• Ability to form effective working relationships with a wide range of individuals.