Highmark Health
Supervisor Case Management - (Remote) Delaware
DE, Working at Home - Delaware
Sponsorship not specifiedDetected 1 day ago
Data AnalysisStatisticsComplianceAccessibilityProject ManagementCustomer SupportHIPAALeadershipCommunicationCollaboration
About the role
- Ensures that care is medically appropriate, high quality, and cost effective.
- The incumbent is accountable for the oversight
- development and maintenance of the department's case management processes.
Responsibilities
- Develop and implement modifications needed, to workload plan, to ensure completion and appropriately coach/counsel staff.
- 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.
- 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.
Requirements
- It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
- As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times.
- Required
- 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).
- Substitutions
- Preferred
- Experience in workforce development and resource management with excellent team building and professional development skills
- Must demonstrate excellent leadership skills and be able to relate to all levels of management and staff as well as individuals external to the corporation.
Nice to have
- 5-7 years of clinical experience
- 3-5 years of experience in case management/managed care
- D ata analytics experience
- Customer Service is preferred,
- Supervisory experience
Skills
- Experience in staff/project management
- Strong leadership, collaboration, l and motivational skills
- Excellent written and verbal communication skills
- Be enthusiastic, innovative and flexible.
- Team player that possesses strong analytical and organizational skill
- The ability to prioritize work demands and meet deadlines
- Excellent computer and software knowledge and skills
- Provide direct reports with guidance and educational tools in order to ensure compliance with NCQA, URAC, DOH, DOL and CMS.
- Display effective communication skills.
Compensation
- Pay Range Maximum:
- Base pay is determined by a variety of factors including a candidate's qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations.
- The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.
Benefits
- Communicate changes in processes and programs in order to enhance a share vision and mission.
- 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.
Company info
- Highmark Inc.
- Job Description:
- This job manages a team of clinicians charged with promoting quality member outcomes, to optimize member benefits, and to promote effective use of resources.
- The incumbent is accountable for the oversight; development and maintenance of the department's case management processes.
- This may include utilization management, strategic planning, care cost initiatives, system development and quality outcomes.
- Hires, trains, coaches, counsels, and evaluates performance of direct reports.
- Ensures compliance with NCQA, URAC, CMS, DOH, and DOL regulations.
- Works closely with other departments within the corporation to resolve issues and ensure activities coincide with Case Management processes.
- Ensure appropriate distribution of workload; monitors/tracks staff completion of assigned work.
- Act as a role model to staff and be able to assist in the day to day activities as needed.
Equal opportunity
- For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org
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This listing is sourced directly from Highmark Health's careers page and normalized into a canonical job model.