Employment Type: Full-Time
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The Manager, Care Management leads teams of nurses and behavior health professionals responsible for care management. The Manager, Care Management works within specific guidelines and procedures; applies advanced technical knowledge to solve moderately complex problems; receives assignments in the form of objectives and determines approach, resources, schedules and goals.
This is a salaried exempt position with responsibilities for the administration, clinical and operational management and compliance with Defense Health Agency policy, URAC Accreditation and federal legislation. The Manager will lead a team of multidisciplinary clinicians and specialists in delivery of care to a specific beneficiary population in accordance with the Autism Care Demonstration (ACD), as it specifically relates to Utilization Management (UM), Case management (CM), Care Coordination (CC) and Quality Management (QM) for TRICARE East; maintaining contractual standards, improving clinical and financial outcomes, and exceeding beneficiary expectations. The Manager will provide clinical guidance, operational oversight and support to the ACD team influencing HGB’s ability to achieve the strategic priorities related to T2017 Contract. The Manager will be responsible for workload management, monitoring of caseloads and distribution; provide coverage for all holidays, both standard and non-standard, as well as support contingency operations. Additionally, must be able to manage multiple direct reports and business relationships for projects, which require flexibility, and adaptability for evolving government regulations.
Key Accountabilities - Manage all aspects of day-to-day operations of the ACD Team to ensure identified contractual requirements are met. This includes oversight of all ACD authorization activities to include, medical necessity review, case management, care coordination, ABA queue call management and performance standards; Establish and maintain open communication and collaborative relationships with other managers, HGB associates, providers, MTFs, eMSMs, to resolve beneficiary or provider complaints and grievances and/or DHA concerns as necessary; Coordinates and implements contingency operations when needed. Implement operational metrics to ensure attainment of the programs’ goals and performance standards. Collaborate with all Humana operations departments to operate and improve processes related to ACD team performance and monitor the effectiveness with the highest degree of attention to beneficiary and provider experience; Support the strategies for efficiency and system improvement, including monitoring the implementation of process changes; Provides area oversight and interfaces with quality management and medical management programs ensuring beneficiary coordination of care. Assist in the collection, analyzation and updates on a variety of referral, authorization, provider steerage and utilization management data; Analyze operational reports to reduce errors, increase data accuracy, review provider availability, and monitor un-activated referrals; Evaluates and applies performance and outcome results to improve organizational policies and procedures, to maximize workflow and efficiency, and to create best value for our beneficiaries and Government partners . Maintain training documents, job aides and assist in ensuring documents are updated as needed for process changes. Leads by example and complies with Humana Government Business Values and Talent Leadership expectations, including hiring, supervising, and training assigned associates
Required Qualifications Our Department of Defense Contract requires U.S. citizenship for this position. Successfully receive interim approval for government security clearance (eQIP - Electronic Questionnaire for Investigation Processing) A current, valid, and unrestricted license to include: Licensed Masters Social Worker (LMSW-ACP), Licensed Professional Counselor (LPC), Psychologist (PhD), Registered Nurse (RN) or other professional license Must have an active designation as a Certified Care Manager (CCM) or be able to obtain within the first year of hire Knowledge of and experience with applied behavior analysis and integrated care needs for those with autism Minimum of five (5) years of managed care, UM, CM, QM or DM experience Minimum of three (3) years of clinical supervisory experience and personnel management Ability to handle multiple projects simultaneously and to prioritize appropriately
Skilled written and verbal communications Comprehensive knowledge of all Microsoft Office applications, including Word, Excel and PowerPoint Must have a separate room with a locked door that can be used as a home office to ensure you have absolute and continuous privacy while you work Must provide a high speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 10x1 (10mbs download x 1mbs upload) is required Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Preferred Qualifications Prior experience with the TRICARE Autism Care Demonstration Minimum of ten (10) years of post-degree clinical experience Experience in budget planning, tracking performance against daily and weekly metrics, and operational experience Extensive analytical skills
Scheduled Weekly Hours
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