- Work closely with the HS Director and other HS Managers to facilitate the development and implementation of new programs and processes to support ongoing success of department goals and initiatives, including but not limited to; ongoing activities related to physical and behavioral health integration and the development of a cohesive team approach to care management.
- Foster effective teamwork and performance. Manage change and encourage innovation. Build collaborative relationships, encourage involvement and initiative and develop goal orientation in others.
- Take a leadership role in initiation and implementation of departmental process/performance improvement activities Responsible for process improvement and working with other departments to improve interdepartmental processes. Utilize LEAN methodologies for continuous improvement. Utilize visual boards and frequent huddles to monitor key performance indicators and identify improvement opportunities.
- Serve as back-up for the Director of Care Management and Utilization Management Manager, as needed.
- Work collaboratively with the UM Director and Manager Team to develop, implement, and oversee the utilization management process to include; coordination of prior authorization needs for members engaged with care management, as well as the inpatient concurrent review process to ensure medical appropriateness, care coordination needs, and discharge planning for PacificSource patients who have been hospitalized.
- Develop and oversee the care management process to ensure care coordination and case management needs of PacificSource's are being met and their outcomes are being improved.
- Ensures consistent workflow and a comprehensive database of patients enrolled in care management and care coordination programs that allows for tracking of case loads, case management program success or failure, and patient and population outcomes.
- Ensure nurse case managers are providing timely notification of large cases to finance, underwriting, stop loss and other company leaders, as necessary.
- Serve as key driver and participant to ensure PacificSource care management programs are coordinated with the case management and care coordination functions of our provider and community partners.
- Responsible for oversight, management, deve
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Case Management Manager - Tacoma, United States - PacificSource
Description
Base Salary Range:
$88, $155,609.24 Looking for a way to make an impact and help people? Join PacificSource and help our members access quality, affordable care PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.
Diversity and Inclusion:
PacificSource values the diversity of the people we hire and serve.
We are committed to creating a diverse environment and fostering a workplace in which individual differences are appreciated, respected and responded to in ways that fully develop and utilize each person's talents and strengths.
Manage the daily operations, including oversight/supervision of the Care Management Team which may include the following:Health Services Representatives (HSR) Member Support Specialists (MSS) and Nurse Case Managers (NCM) and Behavioral Health Clinicians involved in care coordination and case management functions.
Key participant in Health Services (HS) strategy, program development and implementation.Integrally involved in, and accountable for, the success of the PacificSource Care Management program development and performance internal measures as well as those established by regulatory entities.
Essential Responsibilities:
Case Management Manager professionals in Tacoma
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Zakisha Stevens
I’m an motivated hardworking energetic individual.I have high expectations when it comes to customer ...
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Ajjahnae Brown
I’m a responsible and positive person, also dedicated to my job and believe I will get along well wi ...
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Erika Foldyna
Participatory Research and Evaluation
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Jennifer Wamsley
Talk is cheap action is... priceless
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Edward Caldwell
I have years of experience golfing and instructing golf
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Randi Edwards
Assistance