Care Coordinator Supervisor - HYBRID

Position Summary :

The Care Coordinator Supervisor provides day-to-day leadership support to staff and oversight of the continuum of case management services including Care Coordination, Care Transition support, Health Coaching, and Wellness.

The supervisor champions initiatives for the purposes of continuous quality improvement in service delivery to members, improved health outcomes, enhanced staff engagement, and optimum accreditation status.

The supervisor understands and adheres to all relevant guidelines including URAC, Centers for Medicare and Medicaid Services (CMS), Department of Insurance, Department of Labor, and State and Federal regulations.

The supervisor is responsible for monitoring staff competency, productivity, and providing coaching / counseling to remedy deficiencies.

Qualifications :

EDUCATIONAL REQUIREMENTS

College Diploma in Nursing or Associate's Degree in Related Field

CERTIFICATION & LICENSURE REQUIREMENTS

Licensed Social Worker (LSW) Illinois upon hire or Licensed Clinical Social Worker (LCSW) Illinois upon hire or Registered Professional Nurse (RN) License Illinois upon hire or Certified Case Manager within 1 year or Chronic Care Professional (CCP) Certification within 1 year or Certified Rehabilitation Counselor (CRC) within 1 year.

EXPERIENCE REQUIREMENTS

Two (2) Healthcare / Medical - Care Coordination or Two (2) Healthcare / Medical - Utilization Review or Five (5) Healthcare or Five (5) Managed Care.

Formal or informal leadership, health care delivery systems and basic data analytics.

SKILLS AND KNOWLEDGE

Projects a professional, pleasant image while interacting with members / caregivers, providers, staff, and peers. Able to make independent decisions and judgments within the scope of the position.

Strong problem-solving skills, sense of personal accountability and adaptability. Plans, prioritizes, and completes assigned tasks with minimal supervision.

Possesses excellent written and verbal communications skills with exceptional telephone etiquette. Proficient with Microsoft Office products and web based applications, above average typing capability.

Essential Functions :

• Ensures goals of care coordination are incorporated and monitored in day to day activities, which include : achievement of optimal health, access to care, and appropriate utilization of resources, balanced with the member's right to self-determination.
• Serves as regional team leader accountable for staff scheduling, coaching, ongoing development and performance appraisals, providing information / feedback to the Manager of Outpatient Care Coordination.
• Hold staff accountable to performance expectations and implements action plans for performance improvement when needed.
• Develops and maintains relationships within their assigned region, including but not limited to relationships with providers specifically to meet identified needs and goals of provider-focused initiatives
• Identifies opportunities and develops and implements plans to improve workflow efficiency and efficacy to create cohesive intra- and interdepartmental teams that promote excellence in internal and external customer service and satisfaction.
• Performs business and technical functions to achieve department goals and objectives within organizational framework through assigned projects, software integration, committee participation, policy and procedure processing, outcome data collection, process improvement activities, and ad-hoc projects.
• May assist with preauthorization process, with an understanding and application of current healthcare guidelines, clinical knowledge, and understanding of timeliness / appropriateness of medical services related to effective cost management.
• Ensures staff is properly trained and supported to perform all essential job functions.
• Reviews targeted admissions from reports, data and referrals for assignment in CCM and CTI programs.
13 days ago