Manager, Care Management 8/20/2016

WellCare Health Plans Newark, NJ

Company
WellCare Health Plans
Job Classification
Full Time
Company Ref #
28891587
AJE Ref #
575945639
Location
Newark, NJ
Job Type
Regular

JOB DESCRIPTION

APPLY
Location - New Jersey

Manages the activities of supervisory associates and their subordinate work group(s), and/or exempt individual contributors for assigned area of responsibility. Works with the Care Managers to assess, plan, implement, coordinate, monitor and evaluate services and outcomes to maximize the health of the member.

ESSENTIAL FUNCTIONS:

* Manages and develops direct reports who include supervisory and/or exempt professional personnel, including but not limited to hiring, focal point reviews, PiPs, terminations, etc.
* Develops and implements care management workflows and policies & procedures.
* Partners and collaborates with other departments cross-functionally regarding care management and/or Health Service initiatives.
* Manages and resolves e-mails and escalated phone issues in response to provider, staff, and other departmental requests.
* Directs work assignments, measures results, and initiates personnel actions as required.
* Develops, implements, and manages process improvement initiatives.
* Establishes objectives, schedules, and manages cost data for Care Management department.
* Coordinates activities of unit to meet contractual company deadlines and resolve interpersonal conflicts.
* Applies a comprehensive knowledge of Care Management to the completion of assignments.
* Proactively monitors appropriate metrics to drive up efficiency.
* Chairs Care Management committees as applicable.
* Maintains current knowledge of care management topics and acts as the unit's subject matter expert (SME) on care management at department and company meetings.
* Performs special projects as necessary.

CANDIDATE EDUCATION:

* Required A Bachelor's Degree in Nursing or Health Admnistration

CANDIDATE EXPERIENCE:

* Required 5+ years of experience in Current care/case management
* Required 3+ years of experience in Managed Care
* Required 1+ year of management experience

CANDIDATE SKILLS:

* Intermediate Ability to work independently Ability to work independently, handle multiple assignments and prioritize workload
* Intermediate Demonstrated time management and priority setting skills
* Intermediate Ability to work in a fast paced environment with changing priorities
* Intermediate Ability to drive multiple projects
* Intermediate Demonstrated written communication skills
* Intermediate Demonstrated interpersonal/verbal communication skills
* Intermediate Ability to create, review and interpret treatment plans Ability to create, review and interpret treatment plans
* Intermediate Demonstrated negotiation skills
* Intermediate Ability to lead/manage others
* Advanced Knowledge of healthcare delivery
* 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
* Intermediate Ability to implement process improvements
* Intermediate Knowledge of medical terminology and/or experience with CPT and ICD-9 coding

LICENSES AND CERTIFICATIONS:

* Required
* Preferred

TECHNICAL SKILLS:

* Required Intermediate Microsoft Outlook Intermediate to high level efficiency in Microsoft Office including Outlook, Word and Excel
* Required Intermediate Microsoft Word
* Required Intermediate Microsoft Excel
* Required Intermediate Healthcare Management Systems (Generic) Intermediate to high level efficiency in Visio preferred
* Preferred Intermediate Microsoft Visio