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Manager Integrated Care Management

AmeriHealth Caritas

Southfield, MI

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JOB DETAILS
SKILLS
Administrative Skills, Budgeting, Business Strategy, Case Management, Certified Case Manager (CCM), Change Management, Clinical Medicine, Communication Skills, Contract Management, Cost Effectiveness Analysis, Cross-Functional, Diversity, Federal Laws and Regulations, Financial Statements, Healthcare, Leadership, Licensed Clinical Social Worker (LCSW), Maintain Compliance, Managed Care, Management Strategy, Microsoft Excel, Microsoft Office, Microsoft PowerPoint, Microsoft Word, National Committee for Quality Assurance (NCQA), Nursing, Operations Management, Policy Development, Problem Solving Skills, Process Improvement, Process Management, Program Evaluation, Project/Program Management, Quality of Care, Registered Nurse (RN), Regulations, Regulatory Compliance, Regulatory Reports, Regulatory Requirements, Social Work, Staff Training, State Laws and Regulations, Strategic Planning, Team Lead/Manager, Team Player, Time Management
LOCATION
Southfield, MI
POSTED
Today
Role Overview: The Manager, Integrated Care Management, is responsible for leading the day-to-day operations of the Integrated Care Management team, overseeing the development, implementation, and performance of clinical care management programs.


Work Arrangements:


+ Remote - Associate must reside in Michigan (MI)


Responsibilities:


+ Plans, organizes, and directs the development and implementation of clinical care management programs.

+ Ensure staff are adequately trained, oriented, and provided with regular professional development.

+ Identifies opportunities for improvement, both clinical and administrative, and assists the Director in strategic planning.

+ Coordinates the intake process for the new Care Management program and determines impacts, timelines, savings, etc.

+ Coordinates and implements the development of recommended policies.

+ Coordinates, establishes, and monitors achievement of departmental goals and objectives.Responsible for collaborating with lines of business to assist in ensuring care management programs abide by all National Committee for Quality Assurance (NCQA) compliance standards and comply with all applicable state and federal laws

+ Directs the effectiveness of existing programs and services.

+ Identifies and evaluates new programs and services to address cost-effectiveness, proposed process improvements, and compliance with NCQA and State-incentivized health outcomes.

+ Participates in and supports the corporate Medical Management Strategy.

+ Monitors monthly financial statements for the area of responsibility to determine and recommend adjustments.

+ Monitors and manages contractual compliance and regulatory requirements and reporting

+ Facilitates effective communication both within and between departments to exchange information about quality of care, member concerns, and cost-efficient services.

+ Performs other duties as assigned.


Education & Experience:


+ Bachelor’s degree in nursing or a related healthcare field required

+ Unrestricted licensed Registered Nurse (RN) in MI license

+ Master’s degree in social work with a current, unrestricted MI LMSW or LCSW license

+ 8 to 10 years of progressive healthcare or managed care experience

+ 5 years of leadership or case management leadership

+ 1 year of project management experience required

+ Experience managing clinical operations, including budgeting, staffing models, and change management

+ Designation of Certified Case Manager is preferred


Skills & Abilities:


+ Strong leadership and team management skills

+ In-depth knowledge of care management, population health, and clinical operations

+ Knowledge of healthcare regulations, standards, and compliance requirements

+ Ability to manage multiple programs and priorities in a fast-paced environment

+ Strong problem-solving skills

+ Creates and supports an environment that fosters teamwork, cooperation, respect, and diversity

+ Excellent communication and cross-functional collaboration abilities

+ Establishes and maintains positive communication and professional demeanor with associates, providers, and acts as liaison with outside entities as required

+ Demonstrates and supports commitment to corporate goals and mission

+ Proficient in program reporting and meeting deadlines

+ Proficiency with Microsoft Office tools (Excel, Word, PowerPoint)
As a company, we support internal diversity through:

Recruiting. We are an equal opportunity employer. We do not discriminate on the basis of age, race, ethnicity, gender, religion, sexual orientation, or disability. Our inclusive, equitable approach to recruiting and hiring reinforces our commitment to DEI.

About the Company

A

AmeriHealth Caritas

Leaders in health care solutions for those most in need

AmeriHealth Caritas is the nation's leader in providing comprehensive health care solutions for those in most need and the chronically ill. We impact the lives of more than 5.7 million members nationwide. With more than 30 years of experience managing care for individuals and families in publicly-funded programs, we have become known for developing innovative solutions that help improve health outcomes while reducing costs.

Our mission, our goal

Our mission is to help people get care, stay well and build healthy communities. Our goal is to provide responsible managed care solutions, including Medicaid, Medicare, and CHIP - plus behavioral health, pharmacy benefits management and third-party management and administrative services.

COMPANY SIZE
5,000 to 9,999 employees
INDUSTRY
Healthcare Services
FOUNDED
1985
WEBSITE
http://www.amerihealthcaritas.com

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