The Supervisor of Care Management (CM) is responsible for monitoring the CM clinical staff daily work and activities including but not limited to ensuring proper staffing and coverage, monitoring and evaluating departmental operations to ensure optimal efficiency and effectiveness. The position also assist in triaging identified issues/problems and forming resolution within the scope of work. Escalates appropriate issues to CM Manager.
This position is responsible in assisting and developing a successful and cohesive unit, with high level of productivity and accuracy to achieve the department's overall performance metrics. The position supports the CM Manager. The position also assists CM Manager in identification of training needs including but not limited to assisting in development of programs, training materials, competency checklist, and orientation checklists necessary to meet education and training needs of CM staff. This position is also responsible for ensuring all functions are operating in accordance with the organization's mission, values and strategic goals, which are focused on continuous improvement; and are provided in a manner that is responsive and sensitive to the needs of L.A. Care's culturally diverse membership.Duties
Supervises the day to day activities of Case management staff, including but not limited to: Staffing, assignment distributions and time off requests; Monitoring of staff's performance including productivity and compliance with regulatory requirements; Handling all questions/issues raised by staff and knowledge to know when to escalate to the manager. Recommends process improvement measures to achieve department's performance measures outcomes and goals. Plans and directs CM activities according to model of care, program description and policy and procedures to provide timely, quality care and services to members and Interdisciplinary Care Team.
Functions as supervisor in assigned line of business and responsible for identifying the training needs including but not limited to assisting in the development of programs, training materials, orientation checklist, and competence checklist necessary to meet educational needs. Responsible raining new staff and cross-training in specified line of business. Developing tools and workflows to assist in training and development of staff. Completes evaluation of staff and provides recommendation in the hiring and termination process of staff. Monitor staff's performance, identifies and communicates areas that needs performance management to ensure employee compliance with regulatory requirements, policies and procedures.
Develop and maintain positive working relationships with all business partners to ensure optimum member care and provider satisfaction. Serves as a leader and role model as well as technical and informational resource for staff and peers. Foster a culture that encourages employee contribution to ensure that the department maintains an environment in which quality flourishes and recommends resources to reach new standards.
Maintain all assigned reporting responsibilities. Conducts regular audit activity via department's performance reporting standards to maintain quality care of members and compliance to regulatory requirements. Assures the accuracy of CM reports and department proficiency in maintaining regulatory standards and time frames. Provides reports to manager to identify trends and improve work flow process.
Ensure department compliance with Health Insurance Portability and Accountability Act (HIPAA) regulations relating to protection of personal history information (PHI).
Perform other duties as assigned.Education Required Master's Degree In lieu of degree, equivalent education and/or experience may be considered. Education Preferred Associate's Degree in Nursing Bachelor's Degree in Nursing Experience
Minimum of 3 years of recent care management experience in a hospital or managed care setting, such as a health insurance environment and/or experience as care manager in home health or hospice environments with at least 3-4 years supervisory/management experience.
Knowledge of state, federal and regulatory requirements in Care Management.
Strong verbal and written communication skills.
Computer literacy with proficiency with Microsoft Word, Excel, etc. and core departmental system.
Excellent organizational, time management and interpersonal skills.
Must be detailed oriented and an enthusiastic team player.
Ability to work independently and with internal and external customers.
Ability to solve complex issues and identify and implement creative solutions.Licenses/Certifications Required Active & Current Driver's License, with a clean record and Auto Insurance Required Licensed Clinical Social Worker (LCSW) - Active, current and unrestricted California License Licenses/Certifications Preferred Registered Nurse (RN) - Active, current and unrestricted California License Certified Case Manager (CCM) Required Training Additional Information
Please note that a Licensed Clinical Social Worker is only required when Master's Degree in Social Work. Licensed Clinical Social Worker not required with Associate's or Bachelor's Degree in Nursing.
Department: Care Management
At L.A. Care, we value our team members' safety. In order to keep our work locations safe, each employee is required to self-screen for symptoms prior to entering any L.A. Care location each day. L.A. Care and all of its staff are required to comply with all state and local masking orders. Therefore, when on-site at any L.A. Care location, employees are expected to wear a mask in areas where physical distancing cannot be managed.
As a condition of employment, L.A. Care requires a COVID-19 vaccine. This requirement includes our remote workforce. If you would like to request an exemption, L.A. Care has implemented a process to consider exemptions, for documented medical conditions and sincerely held religious beliefs. L.A. Care will review all exemption requests prior to proceeding with the recruitment process.
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