Manager, Care Management

Location: Tigard, OR, United States
Position Purpose: Perform duties to conduct and manage the day to day operations of the care management functions communicating with departmental and plan administrative staff to facilitate daily department functions.
 
  • Manage the delivery of services to members, ensuring services are appropriate and cost effective.
  • Ensure compliance with government and company requirements in the care management department. Develop and implement new procedures, regulatory filings and manage compliance issues.
  • Develop, implement, and oversee care management policies and procedures and give specific guidance to staff and departments as appropriate.
  • Develop, implement, and maintain care management programs to facilitate the use of appropriate services and resources in order to maintain the member in the least restrictive environment.
  • Direct the daily activities of care management staff. Facilitate on-going communication between case management staff, members, contracted providers, and subsidiaries.
  • Develop staff skills and competencies through training and experience.
  • Manage resolution of complaints, and assist in audits and evaluations related to the Long Term Care Program. If necessary, develop and implement corrective action plans.

Qualifications:
Education/Experience:
  • Bachelor’s degree in Social Work, Sociology, Psychology, Nursing, Gerontology, related field or LPN/RN.
  • 6+ of long term care related experience.
  • Thorough knowledge of case and/or utilization management.
  • Familiarity with Medicaid managed care practices and policies, CHIP, and SCHIP.
  • Previous experience as a lead in a functional area, managing cross functional teams on large scale projects or supervisory experience including hiring, training, assigning work and managing the performance of staff. 

License/Certification: Valid driver's license.
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