Job Description

The Case Management Supervisor will support the Health Services Department in achieving clinical quality and service objectives by facilitating the Case Management processes. In addition, directs and coordinates activities associated with the day-to-day operations of the Case Management team under the direction of the Manager of Case Management

 

ESSENTIAL DUTIES AND RESPONSIBILITIES

  1. Supports in oversight of the day-to-day operations of clinical, non-clinical and administrative staff.
  2. Supports in monitoring of adherence related to MOC activities, including HRA, individualized care plan, interdisciplinary care team and care transitions.
  3. Monitors assigned daily operational reports for accuracy and timeliness.
  4. Distributes and assigns tasks to Case Management staff as directed.
  5. Monitors Case Management phone and fax queues on a daily basis.
  6. Coordinates for member case reviews with Medical Director(s), Behavior Health Practitioner(s) and Primary Care Provider as needed.
  7. Works collaboratively with leaders of Utilization Management to quickly and efficiently address any Care Management or Utilization Management concerns or barriers.
  8. Identifies process improvement opportunities and assists in development, implementation and monitoring of action plans based upon identified Care Management metrics.

QUALIFICATIONS

  • Knowledge of Dual Eligible Special Needs Plans, Centers for Medicare and Medicaid Services (CMS), and Florida Medicaid
  • Understanding of Case Management best practices
  • Ability to multi-task and prioritize work.
  • Ability to adjust based on business/department needs.
  • Effective communication (listening, verbal and written) skills.
  • Proficient in Microsoft Word, Excel, and Outlook required.
  • Good organization/attention to detail.

 WORK EXPERIENCE

  • 2-5 years of (or above) experience in Case/Care Management.
  • Problem solving proficiency; the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action.

LANGUAGE SKILLS 

Fluent in English and Spanish.