Case Management Manager - Boise, United States - PacificSource
Description
This job was posted by : For more information, please see: 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.
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:
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.
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.
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, development, implementation, and communication of HS case mana ement and care coordination programs that coordinate and augment community partner programs.
Facilitate the provision of exceptional customer service to members, providers, employers, agents, and other external and internal customers. Ensure that the delivery of services meet acceptable standards and company and customer expectations.
Monitor, evaluate, and report performance relating to volumes, quality, outcomes, accuracy, customer service, and other performance objectives.
Serve as a liaison with all PacificSource departments to coordinate optimal provision of service and information.
Serve as a resource and participate in development of policies, procedures, and operations.
Collaborate and coordinate Health Services department staff between regional offices.
At regional offices, represent Health Services by serving on management teams and support marketing and development initiatives towards achievement of PacificSource Health Plans goals specific to the region.
Attend continuing education opportunities relevant to case management and care coordination to ensure that PacificSource care management programs maintain current best practices and implement innovative models of care.