Job Summary

This role is a key leader of the integrated community care team and provides clinical and performance oversight of a community care management team that is comprised of complex care managers, care team coordinators and community health workers. This role understands the complexities of co-occurring conditions and social determinants of health (SDoH), how they impact the overall health and wellbeing of our members and strategically identifies and implements integrated processes to improve outcomes. The MCT is responsible for the daily operations of the community care management team based on key performance indicators that include reducing potentially preventable events (e.g., ER visits, hospital admissions), increasing medication adherence, stabilizing chronic conditions and improving self-management, overcoming barriers to care and SDoH needs including housing, food and financial instabilities, increasing member engagement with community resources, and member retention.

Oversight functions include department training/onboarding, performance management, clinical oversight/coaching, and case management to NCQA, regulatory, and health plan standards. This role serves as a care management subject matter expert (SME) across the company for both internal and external facing meetings and initiatives. The MCT partners with the general manager, community team and counterparts on the center-based team to deliver integrated care cross the continuum of care. The MCT represents the mission, vision, and values of AbsoluteCare at all times. 

Duties and Responsibilities

• Lead a care management team comprised of licensed registered nurses, social workers, community care team coordinators and community health workers.
• Closely collaborate with the general manager, community team and medical center counterparts to deliver integrated care across the continuum from community to shared services at the center.
• Analyze data to design, implement and measure processes that increase positive health outcomes as evidenced by overall health care cost and utilization reduction.
• Oversee clinical staff development and performance that results in person-centered care planning, SMART goals, clear and consistent documentation, use of evidence-based disease management and chronic care protocols in combination with therapeutic approaches to care including motivational interviewing, trauma informed care, and harm-reduction strategies.
• Manage all caseloads assigned to the care management team to ensure member follow up, timely and accurate documentation, and compliance with company, health plan, and NCQA requirements.
• Facilitate and document outcomes of interdisciplinary community care team (ICT) meetings and ensure follow up is completed and documented for care management related action items.
• Serve as a SME on care management, organization information systems and certain chronic conditions to lead the training and adoption of these approaches to member care for the assigned market, and in new markets, as needed.
• Establish and maintain relationships with community-based organizations to address the chronic care needs of members in the local market.
• Establish and maintain relationships with community based primary care providers and specialists to support regular communication between CCM and care management of members.
• Proactively identify and mitigate barriers to team productivity and member care through data analysis, creative problem solving, and process optimization.
• Use data and operational reports to positively impact utilization, health outcomes, quality metrics, and member satisfaction/retention to care.
• Meet deadlines and manage competing priorities.

Minimum Qualifications

• Clinically licensed in the state of practice with 5+ years of supervisory experience in care management related field including insurance case management, hospital case management or ambulatory care management:
  • Licensed clinician (RN, LCSW, LMSW, LMHC, LPC) by the state in which practicing and abide by all laws, regulations, and requirements. Preference given to qualified case managers with CCM or CMAC credentials. CMGT-BC, CCTM, C-SWCM, C-ASWCM, ACM or FAACM will be considered.
  • Preference given to RN candidates with experience in behavioral healthcare or PMH-BC credentialed –or– SW/Counselor candidates with experience in medical settings or medical case manager roles (Infectious Disease, HIV, Hepatitis C, Organ Transplants).
  • In lieu of CCM credential, 5+ integrated case management experience. Must obtain CCM within 24 months of hire date.
  • Qualified clinical supervisors will be given preference.
• 3+ years of experience serving the needs of complex populations, including medically complex, trauma history, mental health conditions, substance abuse, and socioeconomic barriers in an office or community-based setting.
  • Preference given to qualified candidate with multiple settings experience (Inpatient, LTPAC, home health, corrections, community programs and/or human service agencies.)
  • Experience with complex government-sponsored populations preferred, e.g., Medicaid, Medicare beneficiaries.
  • Experience with member engagement, transitions of care, clinical care, and/or case management
• Advanced computer skills with proficiency in Outlook, Word, Power Point, Excel.
• Experience working in multiple electronic health records.
• Excellent oral and written communication skills with ability to format and present to internal and external stakeholders.
• Excellent leadership skills with proven record of developing and maintaining team morale, high productivity levels, and minimal undesirable staff attrition.
• Excellent organizational and time management skills to prioritize and meet deadlines.
• Ability to analyze data to identify and implement process improvements.
• Proven record of ability to lead through change in a dynamic environment.  
• Hold and maintain active driver’s license and proof of insurance in state of practice.