Team Lead Clinical Operations - Care Management - Must Reside in Mississippi

Job Summary:

The Team Lead, Clinical Operations - Care Management provides front line management and oversight for providing CareSource members with the right care at the right place at the right time and assisting them to achieve optimal clinical, financial, and quality of life outcomes. They are responsible for assisting in developing and executing the care model, aligning to corporate goals.

Essential Functions:

• Support Care Management (CM) process for care coordination, provide support for UM cost drivers
• Utilize various reports to identify team concerns & support strategy for resolution
• Consult inside and outside of department and act as a SME for training enhancements as needed.
• Provide 1:1 support and or group support as needed to staff to improve CM metrics and results.
• Provide leadership and direction to staff to ensure the goals, standards, and compliance with CareSource, federal and state regulatory requirements are met
• Responsible for coaching and development of staff, and support continuing education
• Perform ongoing monitoring of staff performance, scheduling, caseload allocation, productivity and quality to ensure equitable workload distribution based on staff strengths, skills and business needs
• Contribute to continuous quality improvement
• Serve as interdepartmental liaison and network with other departments to gather/share information about issues
• Assist in the development and review of department policies, procedures and processes
• Collaborate with other organizational departments on integration of cross departmental processes to achieve optimal efficiencies
• Promote operational excellence through process improvement and change management
• Collaborate with internal resources in monitoring service levels to meet requirements and analyze for trends
• Oversee departmental Clinical Quality initiatives and activities
• Participate in meetings with internal/external resources to provide information about services and benefits available to members and referral mechanisms
• Assist in arranging and coordinating services with community partners to maximize utilization of appropriate community resources and support groups
• Oversee appropriate system documentation within defined protocols and guidelines
• Participant in development of budget and perform ongoing monitoring of status
• Lead by example and "inspect" behavior to ensure that every interaction the employees have with our members will help the member to feel informed, empowered, and supported by CareSource
• Report team results that demonstrate engagement rates, low Grievances & Appeals, continuous Improvement and other metrics that show how their behavior is impacting a positive consumer experience
• Conducts meetings as needed (face to face or virtually) to train, lead, and support staff towards the effective administration of CM program.
• Provide support as needed for regulatory activities.
• Promote CM industry standards and best practices in communication with staff.
• Perform any other job duties as requested

Education and Experience:

• Associate's degree in healthcare or related field or equivalent years of relevant work experience is required
• Bachelor's degree is preferred
• A minimum of three (3) years of healthcare experience is required
• A minimum of two (2) years of managed care and/or case management experience is preferred
• Previous supervisory experience is preferred

Competencies, Knowledge and Skills:

• Proficient in Microsoft Office Suite, to include Word, Excel and PowerPoint
• Ability to operate smart phone, iPad or other mobile communication devices
• Excellent written and verbal communication skills
• Ability to create a positive work environment that promotes employee engagement and goal achievement
• Ability to develop, prioritize and accomplish goals
• Effective listening and critical thinking skills
• Ability to work independently and within a team environment
• Knowledge of state and federal healthcare regulations and environment
• Awareness of community and state support resources for populated served
• Proven track record of leading teams focused on the consumer / member experience that demonstrated empathy and compassion and tracked results
• Proven track record in driving continuous improvement efforts to improve member experience and tracked results

Licensure and Certification:

• Active, unrestricted State Licensed Practical Nurse (LPN), Registered Nurse (RN) license, Social Work license, or Counselor license is required
• Healthcare or Management certification is preferred
• To help protect our employees, members, and the communities we serve from acquiring communicable diseases, Influenza vaccination is a requirement of this position. CareSource requires annual proof of Influenza vaccination for designated positions during Influenza season (October 1 - March 31) as a condition of continued employment. Employees hired during Influenza season will have thirty (30) days from their hire date to complete the required vaccination and have record of immunization verified.
• CareSource adheres to all federal, state, and local regulations. CareSource provides reasonable accommodations to qualified individuals with disabilities or medical conditions, sincerely held religious beliefs, or as required by state law to enable the employee to perform the essential functions of the position. Request for accommodations will be completed through an interactive review process.

Working Conditions:

• General office environment; may be required to sit or stand for extended periods of time
• Ability to travel as required by the needs of the business

HCQI Model Role: Team Lead

Does this job title support quality? Yes

Detailed description of HCQI activities performed:

Provides oversight of staff performance to ensure:

• Quality of member care
• Appropriate care management and cost effective service utilization
• Assists with resolving barriers to care and member issues
• Facilitates ICT meetings
• Tracking and monitoring of quality metrics
• Assist with implementation of inventions to maintain and/or improve the quality and efficiency of the operations/services provided
• Audits cases and administers timely feedback and training
• Provide leadership, coaching and direction to staff to ensure the goals, standards, and internal compliance and federal and state regulatory requirements are met
• Performs ongoing monitoring of staff performance, scheduling, caseload allocation, productivity and quality to ensure equitable workload distribution based on staff strengths, skills and business needs

Percentage of time spent on HCQI activities:

• Case Management: 40%
• Disease Management: 5%
• Discharge Planning/Readmission Prevention: 10%
• Medical Director Oversight: 0%
• Medication Therapy Management: 5%
• Community Advocacy: 0%
• Quality Data Analytics & Reporting: 25%
• Provider Engagement: 10%
• Technology that Supports Quality Initiatives: 0%
• Other: 0%
• Total Time Spent on HCQI Activities: 95%

HCQI Activities Category: Improve Health Outcomes

Compensation Range:
$63,720.00 - $101,880.00 CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type:
Salary

Competencies:
- Create an Inclusive Environment
- Cultivate Partnerships
- Develop Self and Others
- Drive Execution
- Influence Others
- Pursue Personal Excellence
- Understand the Business

TrueCare is a Mississippi non-profit, provider-sponsored health plan formed by a coalition of Mississippi hospitals and health systems throughout the state and supported by CareSource's national leadership in quality and operational excellence. TrueCare offers locally based provider services through provider engagement representatives and customer care. Our sole mission is to improve the health of Mississippians by leveraging local physician experience to inform decision-making, aligning incentives, using data more effectively, and reducing friction between the delivery and financing of health care. By doing so, TrueCare will change the way health care is delivered in Mississippi.

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an inclusive environment that welcomes and supports individuals of all backgrounds.