Summary of Job:
Responsible for the day to day operation and performance of the care management team providing care management services to EmblemHealth members. Provide services in order to monitor team member performance which includes quality, outcome and productivity measures and deploys strategies to improve performance. Provides coaching and mentoring to team members to address performance related issues. Uses problem solving abilities to create solutions to operational and clinical issues identified during day to day operations. Collaborates with the Director and AVP of Care Management and internal audit teams to address audit related findings and implement performance improvement strategies.
Collaborates with other functional areas within organization to ensure that care managers are implementing EmblemHealth Health Plans policies, procedures and all regulatory mandates, consistent with Emblem Health Plans mission, vision, purpose and value statement.
- Manage daily operations of the Care Management team including measurement of performance metrics and productivity standards and deploys strategies that will improve performance.
- Training employees in process operations and acting as a preceptor to newly hired staff. Completes quarterly evaluations of staff as needed.
- Monitor team caseloads and shifts workloads accordingly to meet departmental/organizational needs
- Monitors timeliness and appropriateness of documentation in clinical systems to ensure that documentation meets accreditation and regulatory standards
- Ensures that team members are managing enrollees across the care continuum, inclusive of behavioral health to ensure that enrollees have access to needed care and services
- Serves as a clinical resource and attends Care Management rounds.
- Monitors employees’ performance regularly and coach employees as needed