Care Management Supervisor
We are transforming healthcare to be value-driven, creating a seamless, consumer-centric care experience that maximizes value for all.
We believe that all health consumers are entitled to high quality, coordinated healthcare. We uniquely align the interests of health consumers, providers, and payors to make high-quality healthcare accessible and affordable to all populations across the ACA Marketplace, Medicare, and Medicaid.
JOB SUMMARY
The Care Management Supervisor is responsible for overseeing the coordination and delivery of quality, cost-effective care for a population by leading a team of Care Managers. This role facilitates collaboration across settings, ensures the implementation of care plans, monitors the efficacy of interventions, and advocates for services to support desired health and social outcomes. The Care Management Supervisor provides leadership, guidance, and operational support to ensure patient-centered care across the continuum.
DUTIES & RESPONSIBILITIES
- Supervising and mentoring a team of Care Managers to ensure adherence to best practices and organizational policies.
- Overseeing care coordination, self-management planning, discharge planning, and health education for the assigned population.
- Monitoring care plan implementation and ensuring appropriate interventions to transition members to optimal levels of health and self-management.
- Facilitating interdisciplinary team meetings and ensuring effective collaboration across providers and healthcare settings.
- Ensuring compliance with regulatory standards, including HEDIS measures and NCQA requirements.
- Providing training and ongoing professional development for the Care Management team.
- Evaluating team performance and implementing strategies for quality improvement.
- Assisting in the development and execution of policies and procedures set forth by the Quality Management Committee.
- Maintaining oversight of communication processes to ensure regulatory compliance and member engagement.
- Performing additional duties as assigned.
EDUCATION AND PROFESSIONAL EXPERIENCE
- Minimum associate's degree in nursing or master’s degree in social work or related field.
- Minimum 3-5 years of experience in care management, including at least 1 year in a supervisory or leadership role.
- Working knowledge of HEDIS measures and NCQA standards.
- Active Florida License as a Licensed Vocational Nurse (LVN), RN, LCSW, LMFT preferred.
- Certification in Case Management (CCM) or Managed Care Nursing (CMCN) preferred.
PROFESSIONAL COMPETENCIES
- Strong leadership and team management skills.
- High level of critical thinking and problem-solving skills.
- Effective verbal and written communication skills.
- Ability to manage time effectively, prioritize tasks, and work independently in a fast-paced environment.
- Demonstrated flexibility, organization, and self-motivation.
- Highly adaptable to change and process improvement initiatives.
- Strong work ethic and positive attitude.
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