SENIOR MANAGER OF COMPLEX CARE COORDINATION, COMMUNITY CARE

JOB SUMMARY

The Senior Manager of Complex Care Coordination, Community Care provides leadership and support of the Community Based Complex Care Coordination in collaboration with the Director of Complex Care Coordination.

Oversees functions of Complex Care Coordination, including report analytics, service level agreements, member grievances, project implementation and daily operations.

Represents the department during audits and meetings with Health and Family Services (HFS), Health Services Advisory Group (HSAG) and National Committee for Quality Assurance (NCQA).

Develops and oversees processes, and coordinates communication amongst the Health Plan, Utilization Management, and other covered entities.

Ensures staff is trained on both contractual requirements and best practices for consistent program outcomes. Collaborates with Ambulatory & Community Health Network (ACHN) administrators and providers to support interdisciplinary care team meetings and the continuum of care coordination services.

This position is exempt from Career Service under the CCH Personnel Rules

General Administrative Responsibilities

Collective Bargaining

• Review applicable Collective Bargaining Agreements and consult with Labor Relations to generate management proposals
• Participate in collective bargaining negotiations, caucus discussions and working meetings

Discipline

• Document, recommend and effectuate discipline at all levels
• Work closely with labor relations and / or labor counsel to effectuate and enforce applicable Collective Bargaining Agreements
• Initiate, authorize and complete disciplinary action pursuant to CCH system rules, policies, procedures and provision of applicable collective bargaining agreements

Supervision

• Direct and effectuate CCH management policies and practices
• Access and proficiently navigate CCH records system to obtain and review information necessary to execute provisions of applicable collective bargaining agreements

Management

• Contribute to the management of CCH staff and CCH’ systemic development and success
• Discuss and develop CCH system policy and procedure
• Consistently use independent judgment to identify operational staffing issues and needs and perform the following functions as necessary;

hire, transfer, suspend, layoff, recall, promote, discharge, assign, direct or discipline employees pursuant to applicable Collective Bargaining Agreements

Work with Labor Relations to discern past practice when necessary

Typical Duties

• Leads and manages the Complex Care Coordination staff providing support to Community Based initiatives.
• Ensures compliance of Health Services Advisory Group (HSAG), National Committee for Quality Assurance (NCQA) and Health and Family Services (HFS) program requirements.
• Acts as a liaison and represents Complex Care Coordination during program audits with Health Services Advisory Group (HSAG), National Committee for Quality Assurance (NCQA), Health and Family Services (HFS) and other entities.
• Educates and trains staff on contractual requirements and best practices.
• Collaborates with ACHN leadership to coordinate interdisciplinary care team meetings.
• Manages grant implementation and reporting.
• Identifies opportunities and trends in operational workflows. Makes recommendations to support contract and compliance management.
• Takes a comprehensive approach to evaluate and constructively improve current processes and workflows supporting expansion of the complex care coordination operations
• Analyzes program outcomes and success through tracking, identifying trends and measuring key performance measures.
• Takes corrective action as necessary to address disciplinary concerns; makes recommendations when necessary to diminish the impact on productivity.
• Implements enhanced capabilities for accountability and integrity of daily operations
• Plans, directs and oversees all aspects of assigned products and programs, establishing objectives, policies and procedures.
• Participates in the evaluation of financial performance for the Complex Care Coordination department.
• Facilitates operational oversight for product and program functions and identifies opportunities for improving efficiency and cost reduction.
• Ensures operational processes and policies are compliant with corporate standards and
• applicable local, state and federal regulations.
• Oversees the research and development of any system, product and / or business implementation.
• Adheres to fraud and abuse prevention and / or detection policies and programs according to regulatory requirements.
• Attends and participates in meetings or conferences, as needed.
• Performs other duties as assigned

MINIMUM QUALIFICATIONS :

• Master's degree from an accredited college or university is required (Must provide official transcripts at time of interview)
• Licensed as a Social Worker (LSW), Licensed Clinical Social Worker (LCSW) or Registered Professional Nurse (RN) is required
• Three (3) years of health plan experience in Medicaid or other government lines of business or health system including aspects of operations oversight and management is required
• Three (3) years of experience in a Medicaid Managed Care role with direct product and / or direct program experience in contract compliance, government relations, and / or provider network is required
• Three (3) years of experience with data collection, analysis, and reporting is required
• Two (2) years of experience managing or supervising staff for a Managed Care Organization (MCO) or in a healthcare environment is required
• Prior experience supporting grant management is required
• Experience with new program implementations and oversight is required
• Proficient with Microsoft Office products is required

Knowledge, Skills, Abilities and Other Characteristics

• Knowledge of the principles of Health and Family Services (HFS), Medicaid Managed Care principles and management practices including Health Services Advisory Group (HSAG), National Committee for Quality Assurance (NCQA) and MCG Regulations
• Knowledge of Microsoft Office (Access, Excel, PowerPoint, and Word)
• Knowledge and understanding of implementation, startups and operationalizing Managed Care programs
• Excellent interpersonal, verbal and written communication skills necessary to communicate with all levels of staff and a patient population composed of diverse cultures and age groups
• Excellent program development, management and leadership skills
• Demonstrates good computer and typing skills
• Demonstrate good phone and email etiquette skills with strong response times
• Demonstrate analytical and organizational, problem-solving, critical thinking and conflict management / resolution skills
• Demonstrate attention to detail, accuracy, and precision to support research and presentation skills
• Ability to prioritize, plan and organize projects and tasks
• Ability to multi-task and meet deadlines in a fast paced and stressful environment
• Ability to maintain a professional demeanor and composure when challenged
• Ability to function autonomously and as a team member in a multidisciplinary team
• Ability to train by presenting concepts and demonstrating tasks
• Ability to perform accurate and reliable mathematical calculations to support reimbursement analysis and measure financial performance
• Ability to work flexible hours

VETERAN PREFERENCE

PLEASE READ

When applying for employment with the Cook County Health & Hospitals System, preference is given to honorably discharged Veterans who have served in the Armed Forces of the United States for not less than 6 months of continuous service.

To take advantage of this preference a Veteran must :

• Meet the minimum qualifications for the position.
• Identify self as a Veteran on the employment application by answering yes to the question by answering yes to the question, Are you a Military Veteran?
• Attach a copy of their DD 214, DD 215 or NGB 22 (Notice of Separation at time of application filing. Please note : If you have multiple DD214s, 215s, or NGB 22S, Please submit the one with the latest date.

Coast Guard must submit a certified copy of the military separation from ei

ther the Department of Transportation (Before 9 / 11) or the Department of Homeland Security (After 9 / 11). Discharge papers must list and Honorable Discharge Status.

Discharge papers not listing an Honorable Discharge Status are not acceptable

A copy of a valid State ID Card or Driver’s License which identifies the holder of the ID as a Veteran, may also be attached to the application at time of filing.

If items are not attached, you will not be eligible for Veteran Preference

VETERANS MUST PROVIDE ORIGINAL APPLICABLE DISCHARGE PAPERS OR APPLICABLE STATE ID CARD OR DRIVER’S LICENSE AT TIME OF INTERVIEW

MUST MEET REQUIRED QUALIFICATIONS AT TIME OF APPLICATION

BENEFITS PACKAGE

• Medical, Dental, and Vision Coverage
• Basic Term Life Insurance
• Pension Plan
• Deferred Compensation Program
• Paid Holidays, Vacation, and Sick Time
• You may also qualify for the Public Service Loan Forgiveness Program (PSLF)
30+ days ago