Supervises staff, ensures appropriate workload distribution and oversees day to day workflow processes. Ensures team is compliant with all Model of Care regulatory requirements and produces optimal clinical and resource outcomes. Works with case managers to assess, plan, implement, coordinate, monitor and evaluate services and outcomes to maximize the health of the member.
Assists management in collaborating with Health Services, Operations and Information Technology departments to ensure full integration of case management reporting throughout the organization.
Assists Case Mangers in completing comprehensive assessment and care plans to evaluate the member's need for services.
Monitors associate performance and conducts counseling/corrective action procedures when required. Identifies concerns, brings issues to management's attention and offers suggestions for improvement.
Provides significant input to performance evaluation, hiring and termination decisions for associates in work group.
Reviews time records, sets schedules and approves all vacation/time off requests for subordinate associates.
Provides training and guidance to new and current Case Managers regarding policy & procedure, systemic tools, workload and care plan development.
Answers all questions and assists peers and management with delegated tasks or projects.
Takes the lead in preparing and submitting projects, reports or assignments as needed to meet department initiatives and/or objectives.
Ensures phone or team coverage due to fluctuations in staffing levels.
Ensures regulatory requirements and accreditation standards are applied to all activity and reporting.
Plays active role in creating, applying and utilizing accepted policies and procedures.
Attends company meetings in absence of manager or director.
Performs other duties as assigned
Required An Associate's Degree in nursing or Graduation from Diploma Nursing School or health related or behavioral science field
Preferred A Bachelor's Degree in nursing
Required Other For Illinois' Children with Special Needs program, a Master's degree in Nursing, Social Sciences, social work, or a related field plus 3 years of experience in a human services field is required.
Required Other For Florida Managed Long Term Care program, a Master's degree in human service, social science or health field plus a minimum of 2 years' experience in case management is required.
Bachelor's degree in human service, social science or health field plus a minimum of 5 years' experience in case management is required
Required 4 years of experience in an acute clinical care setting and/or MCO related experience
Required 2 years of experience in current case management
Required Other For Florida Managed Long Term Care program, 1 years elderly and disabled population case management experience.
Intermediate Ability to drive multiple projects
Intermediate Ability to work independently
Intermediate Demonstrated time management and priority setting skills
Intermediate Ability to work in a fast paced environment with changing priorities
Intermediate Demonstrated written communication skills
Intermediate Demonstrated interpersonal/verbal communication skills
Intermediate Ability to create, review and interpret treatment plans
Intermediate Demonstrated negotiation skills
Intermediate Ability to lead/manage others
Advanced Ability to analyze and interpret financial data in order to coordinate the preparation of financial records
Advanced Ability to effectively present information and respond to questions from families, members, and providers
Advanced Ability to effectively present information and respond to questions from peers and management
Advanced Knowledge of healthcare delivery
Intermediate Ability to implement process improvements
Licenses and Certifications:
A license in one of the following is required:
Required Licensed Registered Nurse (RN)
Preferred Certified Case Manager (CCM)
Preferred Other Incumbents supporting New Jersey's LTSS program are not required to have an RN license
Required Intermediate Microsoft Word
Required Intermediate Microsoft Excel
Required Intermediate Healthcare Management Systems (Generic)
Required Intermediate Microsoft Outlook
Preferred Other Bilingual skills
About us Headquartered in Tampa, Fla., WellCare Health Plans, Inc. (NYSE: WCG) focuses primarily on providing government-sponsored managed care services to families, children, seniors and individuals with complex medical needs primarily through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans, as well as individuals in the Health Insurance Marketplace. WellCare serves approximately 5.5 million members nationwide as of September 30, 2018. WellCare is a Fortune 500 company that employs nearly 12,000 associates across the country and was ranked a "World's Most Admired Company" in 2018 by Fortune magazine. For more information about WellCare, please visit the company's website at www.wellcare.com. EOE: All qualified applicants shall receive consideration for employment without regard to race, color, religion, creed, age, sex, pregnancy, veteran status, marital status, sexual orientation, gender identity or expression, national origin, ancestry, disability, genetic information, childbirth or related medical condition or other legally protected basis protected by applicable federal or state law except where a bona fide occupational qualification applies. Comprehensive Health Management, Inc. is an equal opportunity employer, M/F/D/V/SO.