Easter Seals Jobs

PRINCIPAL RESPONSIBILITIES:

Under general direction of the Manager, Case Management, the Supervisor of Case Management will be responsible for the quality of the CM staffs daily work and activities including but not limited to monitoring, developing, implementing, and evaluating departmental operations to ensure optimal proficiency and effectiveness. This role will be responsible for education and coaching of staff on case management process and team integration. Perform regular audits of all disciplines to review detailed clinical information, analyze and interpret clinical documentation, determine relevance, and make clinically sound conclusions. Provide feedback and opportunities identified to the Manager of Case Management. Responsible for the development and maintenance of all training materials and job aids and serves as subject matter expert. Assist in problem solving daily issues and difficult cases with Case Managers, Social Workers, Navigators and Coordinators. Reviews the work of others and identifies opportunities.

Principal responsibilities include:

• Supervise the daily operations of CM staff to ensure appropriate usage of resources in order to facilitate the CM process.
• Identifying the training needs including, but not limited to assisting in the development of programs, training materials, job aids, orientation checklists, and competency checklist necessary to meet educational and training needs of departmental staff.
• Developing tools and workflows to assist in training and development of staff
• Responsible for maintaining any training materials to align with the current process to improve members health outcomes, prevent hospitalizations and meet regulatory requirements.
• Develop and conduct clinical education courses, including case management education and training for new employees, ongoing staff, and cross-training of staff as needed.
• Develop and maintain complex audit processes and audit tools related to care coordination, quality, case management, and data entry.
• Train staff in the use of audit tools and identification of patterns or trends that require additional training or corrective action.
• Educate staff as necessary to ensure consistent performance and adherance to standards
• Audit staff in accordance with established auditing processes, work with staff to identify and resolve errors in data and reporting, and present findings and recommendations for improvement to management.
• Identify opportunities for process improvements to facilitate department functions and ensure compliance within applicable governmental program guidelines.
• Evaluate policies and procedures and analyze/recommend enhancements to ensure adherence to regulatory requirements.
• Assist with ensuring consistent data collection from CM staff that is used to assist the company in achieving strategic goals, to improve monitoring and reporting in order to meet external requirements.
• Assist in writing and implementing business requirements for any software systems that will be used in the assessment, care coordination and case management processes.
• Maintain records of training activities and employee progress
• Assist with revisions to Policy and Procedure and/or work process development
• Participate in Quality and Advisory committees and/or or provider education meetings as needed.
• Prepare for and participate in regulatory audits and develop and monitor corrective actions plans.
• Dental Liaoson duties including but not limited to ensuring entire CM team is available to dental providers, including Denti-Cal providers, to assist with referring Members to other covered services and to assist with care coordination of medical and dental needs.
• Complete other duties and special projects as assigned.

ESSENTIAL FUNCTIONS OF THE JOB

• Supervising, auditing, monitoring, and training of staff.
• Writing, reporting, administration, and an lysis.
• Communicating effectively and efficiently internally and externally.
• Developing long and short range strategic plans for case management activities.
• Making verbal presentations.
• Act as a resource to staff in daily coaching and problem solving.
• Leading and participating in internal and external committees and meetings.
• Complying with the organizations Code of Conduct, all regulatory and contractual requirements, organizational policies, procedures, and internal controls.

PHYSICAL REQUIREMENTS

• Constant and close visual work at desk or computer.
• Constant sitting and working at desk.
• Constant data entry using keyboard and/or mouse.
• Frequent use of telephone headset.
• Frequent verbal and written communication with staff and other business associates by telephone, correspondence, or in person.
• Frequent lifting of folders and other objects weighing between 0 and 30 lbs.
• Frequent walking and standing.

Number of Employees Supervised: 10-15

MINIMUM QUALIFICATIONS:

EDUCATION OR TRAINING EQUIVALENT TO:

• Registered Nurse license, active and unrestricted licensed in the State of California.
• BSN or MSN required
• Advance Nursing Degree preferred.

MINIMUM YEARS OF ADDITIONAL RELATED EXPERIENCE:

• Three to five years healthcare related experience preferred.
• Experience working within the managed care/care management environment preferred.
• 1-2 years of experience in a lead or supervisory role required.
• 4+ years of experience in nursing, training, or auditing in a healthcare setting required.
• Masters in Case Management may be substituted for 2 years of required experience.

SPECIAL QUALIFICATIONS (SKILLS, ABILITIES, LICENSE):

• Knowledge of Medi-Cal and/or Department of Health Care Services and/or Medicare regulations and standards a plus.
• Ability to motivate, train, and supervise.
• Ability to make thoughtful decisions and exercise sound judgment.
• Experience with planning, implementing, and evaluating clinical and disease prevention programs a plus.
• Background in population-based community health assessment and interventions preferred.
• Ability to work effectively in a multidisciplinary approach in management.
• Ability to communicate effectively, both verbally and in writing.
• Experience in use of Microsoft Office suite.

Employees who interact with members of the public may be required to be tested for Tuberculosis and fully vaccinated against COVID-19 and influenza. Successful candidates for those positions/ classifications may be required to submit proof of vaccination against influenza and/or COVID-19, a negative Tuberculosis test, or request an exemption for qualifying medical or religious reasons during the onboarding process. Candidates should not present proof of vaccination until instructed to do so by the Human Resources department.

SALARY RANGE $121,730.28 - $182,595.42 Annually

The Alliance is an equal opportunity employer and makes employment decisions on the basis of qualifications and merit. We strive to have the best qualified person in every job. Our policy prohibits unlawful discrimination based on race, color, creed, gender, religion, veteran status, marital status, registered domestic partner status, age, national origin or ancestry, physical or mental disability, medical condition, genetic characteristic, sexual orientation, gender identity or expression, or any other consideration made unlawful by federal, state, or loc