Care Services Manager

$57,720.00 - $88,504.00

The Care Services Manager is responsible for Social Work functions and interfaces directly with the Senior Care Services Manager to ensure that assessed member needs are effectively addressed. This individual ensures safety, quality of care and experiences for members under the appropriate benefit structure through leadership and oversight to the social work teams and external community organization collaboration.

1. Responsible for supporting and assisting the Senior Care Services Manager for the day-to-day operations and overall performance of the Elderwood IPA Social Work Care Manager (SWCM)
2. Ensures timely escalation and visibility specific to need for appropriately licensed and knowledgeable staffing and/or resources necessary to effectively conduct care management functions across plan population for finance review.
3. Ensures all social work and member services focused care management activities are performed in accordance with contractual requirements, state policy, and plan procedures.
4. Adheres to member goals and outcomes established by the QAPI Work Group and performance objectives and provides effective coaching and mentoring where indicated.
5. In collaboration with the Senior Care Services Manager, help implement processes that support and promote efficient care resulting in optimal clinical outcomes and appropriate utilization of resources.
6. Alerts Provider Relations Manager regarding possible need to negotiate rates for Non-Par Providers; ensures that all necessary paperwork is obtained and appropriately documented in the medical record.
7. In collaboration with the Senior Care Services Manager, performs follow-up phone calls to obtain documentation and/or safe discharge plans for any member visit or admission to Facilities, ER, Hospital.
8. Ensures emergency and disaster preparedness plan is comprehensive and actionable; ensures implementation of timely and prioritized plan emergency management policy.
9. Performs ongoing monitoring of social work and Care Navigator documentation to ensure adherence and identifies process improvement opportunities with appropriate escalation.
10. Monitors the effectiveness of existing procedures and social work outreach efforts in demonstrating positive outcomes and experience for members.
11. Monitors performance against defined operational metrics and establishes mechanisms for reporting..
12. In collaboration with the Senior Care Services Manager and in response to performance data, addresses key care management outcomes and implements improvement activities to maximize ability for closure of service gaps and achieve timely resolution for identified member needs.
13. Identifies and escalates concerns specific to FWA concerns to director in a timely and sensitive manner.
14. Identifies and escalates concerns and/or opportunities for Medicare or other primary payer eligibility and/or application.
15. Performs routine regulatory monitoring and coordinates/participates in external quality and audit activities.
16. Refers cases with quality of care and/or service concerns to the Senior Care Services Manager
17. Participates as requested in QAPI Work Group and Quality Committee, as active and contributing member specific to SWCM and CN functions.
18. Protects member rights at all times.
19. Remains flexible and responsive to changes in schedule, workload or focus.
20. Champions a culture of excellence.
21. Travels to off-site meetings as directed.
22. Arrives to work on time, regularly, and works as scheduled.
23. Recognizes and follows the dress code of the facility including wearing name tag at all times.
24. Follows policy and procedure regarding all electronic devices, computers, tablets, etc.
25. Supports and abides by Elderwood IPA’s Mission, Vision, and Values.
26. Abides by Elderwood IPA’s businesses code of conduct, compliance and HIPAA policies.
27. Performs other duties as assigned by supervisor, management staff or Administrator.

·       Possesses Master’s in Social Work ·       Minimum of six (6) years of Social Work experience with at risk populations in home care, case management, discharge planning or managed care ·       Minimum of four (4) years working as a supervisor or coordinator performing case and/or utilization management functions, with thorough knowledge in assessment, diagnosis, treatment approach for individuals with medical/behavioral conditions, case management methodology, mental health community resources and local health delivery systems ·       Recent experience as a lead in a functional area, managing cross functional projects, and supervisory experience including hiring, training, assigning work and managing the performance of team ·       Previous managed care experience, or working with special needs populations preferred ·       Demonstrated computer skills with Microsoft Office, e-mail systems, electronic medical records, and web-based programs ·       Current, valid driver license ·       In good standing with and demonstrated knowledge of Medicare and Medicaid programs ·       Demonstrated proficiency in HIPAA Privacy and Security compliance

Bilingual Spanish speaking skills preferred

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.