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Manager, Health Care Management Services Long Term Care Job
Date: Dec 12, 2009
Location: Nashville, TN, US
Job Title:
Manager, Health Care Management Services Long Term Care
Job ID:
10762
Location: Nashville, TN
Full/Part Time:
Full-Time
Regular/Temporary:
Regular
JOB SUMMARY:
The HCMS manager is responsible for providing clinical supervision to a team responsible for coordinating member service, utilization, access, and concurrent review to ensure cost effective utilization of health, mental health, and substance abuse services.
PRIMARY RESPONSIBILITIES:
1. Manages and oversees team responsible in case finding and coordinating those cases that involve comorbid conditions and need to be part of the case management/disease management track.
2. Manages and evaluates team's performance and ensure adherence to department's standards
3. Responsible for coordination and service delivery to include member assessment of physical and psychological factors.
4. Works with providers to establish short and long term goals that meet the member's need, functional abilities and referral sources requirements.
5. Communicates care plan objectives utilizing community resources to individuals, departments, and providers identified as having a role in the care of members.
7. Coordinates the identifications of members with potential for high risk complications.
8. Assesses members' present level of physical/mental impairment utilizing defined criteria and methodology.
9. Demonstrates understanding of the physical and psychological characteristics of illness, disabilities and wellness and makes referrals when appropriate.
11. Review benefit systems and cost benefit analysis.
12. Evaluates the member against level of care criteria.
13. Demonstrates knowledge of utilization management targets.
14. Acquires data and evaluates necessary medical, mental health and substance abuse service for cost containment.
15. Requests direction from Medical Director on complex healthcare issues.
16. Maintains member confidentiality and respect of the patient bill of rights.
17. Other duties as assigned.
EDUCATION AND EXPERIENCE:
Education
Required: Bachelors Degree, or equivalent work experience
Preferred: MSN, MPH, MPA, or MSW or related or MBA with Health Care Concentration
Years and Type of Experience Required:
Required: Three years experience in health Care Management
Knowledge and Technical Skills
Required:
· Knowledge of community resources
· Basic Computer skills to include Microsoft Word and Excel
· Ability to provide supervision to multidisciplinary team
· Strong decision making skills
· Ability to provide services in an environment that involves multiple health, mental health and substance abuse care systems.
· Ability to interact with all relevant components of the health and behavioral health care systems
· Self starter with the ability to handle multiple projects at one time.
Certifications or Licensure
Required: RN, or PA, or LSW, or LPC, or LMHC
Preferred: Certified Case Manager
SCOPE INFORMATION
Item Measure
· # Direct Reports 2-10 (or individual contributor in a coaching/training capacity within the department)
· Budgetary $ Responsibility none
PHYSICAL REQUIREMENTS
· Able to operate a computer
· Able to operate a telephone
Equal Employment Opportunity
In accordance with state and federal laws, employment offers are tendered solely on the basis of qualifications without regard to race, religion, color, national origin, age, sex, marital status, sexual orientation, handicap (including disabled veterans) or Vietnam Era veteran status.
AMERIGROUP administers pre-employment drug testing as a condition of employment and a satisfactory criminal history background report.
Manager, Health Care Management Services Long Term Care
Job ID:
10762
Location: Nashville, TN
Full/Part Time:
Full-Time
Regular/Temporary:
Regular
JOB SUMMARY:
The HCMS manager is responsible for providing clinical supervision to a team responsible for coordinating member service, utilization, access, and concurrent review to ensure cost effective utilization of health, mental health, and substance abuse services.
PRIMARY RESPONSIBILITIES:
1. Manages and oversees team responsible in case finding and coordinating those cases that involve comorbid conditions and need to be part of the case management/disease management track.
2. Manages and evaluates team's performance and ensure adherence to department's standards
3. Responsible for coordination and service delivery to include member assessment of physical and psychological factors.
4. Works with providers to establish short and long term goals that meet the member's need, functional abilities and referral sources requirements.
5. Communicates care plan objectives utilizing community resources to individuals, departments, and providers identified as having a role in the care of members.
7. Coordinates the identifications of members with potential for high risk complications.
8. Assesses members' present level of physical/mental impairment utilizing defined criteria and methodology.
9. Demonstrates understanding of the physical and psychological characteristics of illness, disabilities and wellness and makes referrals when appropriate.
11. Review benefit systems and cost benefit analysis.
12. Evaluates the member against level of care criteria.
13. Demonstrates knowledge of utilization management targets.
14. Acquires data and evaluates necessary medical, mental health and substance abuse service for cost containment.
15. Requests direction from Medical Director on complex healthcare issues.
16. Maintains member confidentiality and respect of the patient bill of rights.
17. Other duties as assigned.
EDUCATION AND EXPERIENCE:
Education
Required: Bachelors Degree, or equivalent work experience
Preferred: MSN, MPH, MPA, or MSW or related or MBA with Health Care Concentration
Years and Type of Experience Required:
Required: Three years experience in health Care Management
Knowledge and Technical Skills
Required:
· Knowledge of community resources
· Basic Computer skills to include Microsoft Word and Excel
· Ability to provide supervision to multidisciplinary team
· Strong decision making skills
· Ability to provide services in an environment that involves multiple health, mental health and substance abuse care systems.
· Ability to interact with all relevant components of the health and behavioral health care systems
· Self starter with the ability to handle multiple projects at one time.
Certifications or Licensure
Required: RN, or PA, or LSW, or LPC, or LMHC
Preferred: Certified Case Manager
SCOPE INFORMATION
Item Measure
· # Direct Reports 2-10 (or individual contributor in a coaching/training capacity within the department)
· Budgetary $ Responsibility none
PHYSICAL REQUIREMENTS
· Able to operate a computer
· Able to operate a telephone
Equal Employment Opportunity
In accordance with state and federal laws, employment offers are tendered solely on the basis of qualifications without regard to race, religion, color, national origin, age, sex, marital status, sexual orientation, handicap (including disabled veterans) or Vietnam Era veteran status.
AMERIGROUP administers pre-employment drug testing as a condition of employment and a satisfactory criminal history background report.
Nearest Major Market: Nashville
Job Segments: Healthcare, Management, Manager
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