Manages the day-to-day activities of the Field Service Coordinators and Supervisors. Ensures the case management process of assessing, planning, implementation, coordination, monitoring, and evaluating services and outcomes is pursued to maximize the health of the Member. Promotes effective healthcare utilization, monitors health care resources and assumes a leadership role within the Interdisciplinary Care Team (ICT) to achieve optimal clinical and resource outcomes for member. Oversees the socio economic needs and services of selected member populations across the continuum of illness. Provides ongoing support and oversight to staff.
Provides ongoing consultation to Field Service Coordinators and reviews caseloads on an ongoing basis, both through regular face-to-face supervision sessions and review of management reports and deadlines.
Assists Medical Director and Dir, Field Service Coordination in creating department goals, objectives and metrics.
Oversees the implementation of programs and strategies.
Develops and implements case management workflows and policies & procedures.
Proactively monitors appropriate metrics to drive up efficiency.
Perform audits of assessments, care plans and service notes to verify cases are properly established and that member coordination activities are occurring and appropriately documented.
Coordinates activities of unit to meet contractual company deadlines and resolves interpersonal conflicts.
Partners & collaborates with other departments cross functionally regarding care and case management and/or Health Service initiatives.
Directs work assignments, measures results and initiates personnel actions as required.
Develops, implements and manages process improvement initiatives.
Monitors associate performance and conducts counseling/corrective action procedures when required. Identifies concerns, brings issues to management's attention and offers suggestions for improvement.
Reviews time records, sets schedules and approves all vacation/time off requests for subordinate associates.
Provides training and guidance to new and current Field Service Coordinators regarding policy & procedure, systemic tools, workload and care/case plan development.
Answers all questions and assists peers and management with delegated tasks or projects.
Ensures compliance with all state and federal regulations as well as Corporate guidelines in day-to-day activities.
Performs special projects as needed.
Required A Bachelor's Degree in Nursing or Health Administration
Required 7 years of experience in case management and/or clinical acute care
Required 4 years of experience in managed care
Required 3 years of management experience
Preferred Other Experience in home health, physicians office or public health
Required Other Associates supporting Florida's Children's Medical Services (CMS) will have a minimum of:
five (5) years management/supervisory experience in the health care field, and
three (3) years' experience providing care coordination and two (2) years in managed care or children's services
Preferred Other Associates supporting Florida's Children's Medical Services (CMS) to have experience working:
in care management, children's specialty clinics, or with Patient Centered Medical
with community and family-based services and experience in working across child serving systems recommended
Intermediate Ability to communicate and make recommendations to upper management
Intermediate Demonstrated time management and priority setting skills
Intermediate Ability to lead/manage others
Intermediate Ability to create, review and interpret treatment plans
Intermediate Demonstrated negotiation skills
Intermediate Demonstrated problem solving skills
Intermediate Demonstrated interpersonal/verbal communication skills
Intermediate Knowledge of community, state and federal laws and resources
Intermediate Ability to effectively present information and respond to questions from families, members, and providers
Intermediate Demonstrated written communication skills
Intermediate Knowledge of healthcare delivery
Intermediate Ability to multi-task
Intermediate Demonstrated written communication skills
Intermediate Other Ability to lead and manage others in a metric driven environment
Intermediate Ability to implement process improvements
Intermediate Ability to analyze and interpret financial data in order to coordinate the preparation of financial records
Licenses and Certifications:
A license in one of the following is required:
Required Licensed Registered Nurse (RN)
Required Other Maintain required contact hours to fulfill regulatory requirements
Preferred Certified Case Manager (CCM)
Required Other Associates supporting Florida's Children's Medical Services (CMS) must be a Licensed Registered Nurse (RN) or Licensed Certified Social Worker (LCSW)
Required Intermediate Microsoft Excel
Required Intermediate Microsoft Word
Required Intermediate Microsoft Outlook
Required Intermediate Healthcare Management Systems (Generic)
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.