Lead Transitional Care Manager

2766

Remote?: 0

Highlights (Bonus, shift, relocation, info for job):

Job Description

 

Job title	Lead of TCM
Reports to	UM/TCM Supervisor, Manager or Director (dependent on market structure)
FSLA (HR only)	Exempt
Department	Utilization Mangement
Location	Market

 

Job Summary

The Lead plays a senior staff role in the utilization and transition care management teams, working closely with their direct supervisor to support day-to-day operations. This “working leader” role not only guides and supports other team members but also actively participates in member care and administrative tasks to improve health outcomes, reduce healthcare utilization costs, and enhance care transitions for complex populations. The Lead collaborates with the direct supervisor, shared services, and other stakeholders to promote continuity of care across various healthcare settings and implementation of processes aimed at improving health outcomes, reducing healthcare utilization costs, facilitating effective care transitions and stabilizing chronic conditions for complex populations. Success in role is measured by meeting and/or exceeding KPI targets around caseload, productivity, HFU Visit completion, admissions/1000, admissions/1000, average length of stay and ED utilization.

 

Duties and Responsibilities

• Act as a senior team member, providing guidance to utilization and transitional care management staff, including registered nurses and social workers.
• Support professional development of team by sharing best practices, designing in-services,holding team meetings and individual coaching.
• Support onboarding of new staff by creating onboarding schedule and serving as preceptor for new care management team members by sharing knowledge and guiding workflow processes.
• Offer hands-on assistance with caseload management, ensuring timely documentation and compliance with care standards and health plan requirements.
• Use data and reporting to help monitor team performance, identify improvement areas, and support the supervisor in performance enhancement initiatives.
• Serve as a resource for managing complex cases, addressing medical, behavioral, and social needs using a holistic, patient-centered approach.
• Collaborate directly with inpatient case management staff on discharge planning and continuity of care for complex cases.
• Facilitate effective communication with primary care providers, specialists, and community organizations to address chronic care needs and support care transitions.
• Actively participate in team meetings to build morale, engagement, and collaboration.
• Ensure the privacy and confidentiality of member information, following legal and organizational standards.
• Support adaptable solutions to meet evolving business and patient care needs.
• and innovative solutions to meet changing business needs and priorities.

 

Minimum Qualifications

• Licensure and Education
  • Minimum License: Current, active, and unrestricted license in a health or human services discipline that, within its scope of practice, allows you to conduct an assessment independently (e.g. RN, SW).
  • Minimum Certifications: Qualified with CCM Credentials or obtain within 24 months of hire. CMGT-BC, CCTM, C-SWCM, C-ASWCM, ACM or FAACM will be considered.
  • BLS/CPR required.
  • Education: Minimum degree required for license per state of practice.
• Experience
  • 1-3 years ideally in Value-Based Care, Utilization Management, Transitional Care, or Complex Care Management.
  • Familiarity with complex populations (Medicaid, Medicare, dual-eligible individuals) and experience with medically complex, trauma-experienced, and socially vulnerable individuals.
  • Required for internal only: has been employed by AbsoluteCare for at least 1 year and is a strong individual contributor to their respective programs.
• Technical Skills
  • Proficiency with Microsoft Office Suite and electronic health record (EHR) systems.
  • Strong analytical skills to support performance monitoring and improvement initiatives.
• Interpersonal and Communication Skills
  • Strong verbal and written communication skills for effective interaction with team members, members, families, and interdisciplinary teams.
  • Ability to promote teamwork, manage change effectively, and make sound judgments.

Job Description

 

Job title	Lead of TCM
Reports to	UM/TCM Supervisor, Manager or Director (dependent on market structure)
FSLA (HR only)	Exempt
Department	Utilization Mangement
Location	Market

 

Job Summary

The Lead plays a senior staff role in the utilization and transition care management teams, working closely with their direct supervisor to support day-to-day operations. This “working leader” role not only guides and supports other team members but also actively participates in member care and administrative tasks to improve health outcomes, reduce healthcare utilization costs, and enhance care transitions for complex populations. The Lead collaborates with the direct supervisor, shared services, and other stakeholders to promote continuity of care across various healthcare settings and implementation of processes aimed at improving health outcomes, reducing healthcare utilization costs, facilitating effective care transitions and stabilizing chronic conditions for complex populations. Success in role is measured by meeting and/or exceeding KPI targets around caseload, productivity, HFU Visit completion, admissions/1000, admissions/1000, average length of stay and ED utilization.

 

Duties and Responsibilities

• Act as a senior team member, providing guidance to utilization and transitional care management staff, including registered nurses and social workers.
• Support professional development of team by sharing best practices, designing in-services,holding team meetings and individual coaching.
• Support onboarding of new staff by creating onboarding schedule and serving as preceptor for new care management team members by sharing knowledge and guiding workflow processes.
• Offer hands-on assistance with caseload management, ensuring timely documentation and compliance with care standards and health plan requirements.
• Use data and reporting to help monitor team performance, identify improvement areas, and support the supervisor in performance enhancement initiatives.
• Serve as a resource for managing complex cases, addressing medical, behavioral, and social needs using a holistic, patient-centered approach.
• Collaborate directly with inpatient case management staff on discharge planning and continuity of care for complex cases.
• Facilitate effective communication with primary care providers, specialists, and community organizations to address chronic care needs and support care transitions.
• Actively participate in team meetings to build morale, engagement, and collaboration.
• Ensure the privacy and confidentiality of member information, following legal and organizational standards.
• Support adaptable solutions to meet evolving business and patient care needs.
• and innovative solutions to meet changing business needs and priorities.

 

Minimum Qualifications

• Licensure and Education
  • Minimum License: Current, active, and unrestricted license in a health or human services discipline that, within its scope of practice, allows you to conduct an assessment independently (e.g. RN, SW).
  • Minimum Certifications: Qualified with CCM Credentials or obtain within 24 months of hire. CMGT-BC, CCTM, C-SWCM, C-ASWCM, ACM or FAACM will be considered.
  • BLS/CPR required.
  • Education: Minimum degree required for license per state of practice.
• Experience
  • 1-3 years ideally in Value-Based Care, Utilization Management, Transitional Care, or Complex Care Management.
  • Familiarity with complex populations (Medicaid, Medicare, dual-eligible individuals) and experience with medically complex, trauma-experienced, and socially vulnerable individuals.
  • Required for internal only: has been employed by AbsoluteCare for at least 1 year and is a strong individual contributor to their respective programs.
• Technical Skills
  • Proficiency with Microsoft Office Suite and electronic health record (EHR) systems.
  • Strong analytical skills to support performance monitoring and improvement initiatives.
• Interpersonal and Communication Skills
  • Strong verbal and written communication skills for effective interaction with team members, members, families, and interdisciplinary teams.
  • Ability to promote teamwork, manage change effectively, and make sound judgments.

Why Work at AbsoluteCare?

At AbsoluteCare, we serve the most vulnerable individuals in America. These are our neighbors, people who are at higher risk for disease or who have multiple, complex, chronic illnesses. Often, they deal with an unequal healthcare system and wind up seeking basic care from emergency rooms. We take these patients out of those spaces and turn them into members: people who are entitled to some of the best, most focused care this country has to offer. 

We call this “care beyond medicine.” We have turned the doctor’s office into a comprehensive care center. Here, we surround our members with a core care team of doctors, nurses, social workers, and medical assistants who have the time and skills to get to know our members’ needs. We make the most important services available to our members under one roof. This includes a pharmacy, X-rays, a blood lab, nutrition services, urgent care, and much more.

We don’t stop at our four walls. We engage members in the communities where we all live to find the people who need us most. Through these community care teams, we remove the barriers to healthcare that so many people face daily. And it works. 

Our unique care is guided by our core values of accountability, caring, trust, and teamwork. We call it ACT².

AbsoluteCare, Inc. provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, age, disability, genetics, protected Veteran status, or any other characteristic protected by law or policy.

EEO Employer Verbiage: AbsoluteCare, Inc. provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, age, disability, genetics, protected Veteran status, or any other characteristic protected by law or policy.