Job Description

Review and approve Care Management Team’s care plan and service plan development.

Review requests for clinical consultation services from care management staff.

Ensure that all care management staff are properly and adequately trained and they have the skills and competence to perform the required functions.

Develop and implement on-going staff training related to Care Management and ensure the appropriate tools are available for implementation of policies and procedures, documentation in member record, and measurement and reporting.

Handle requests from members for change in care management team.

Identify areas for improvement of existing operational policies and procedures, develop recommendations to department senior management; and follow through with implementation.

In conjunction with the Director and other departmental managers, manage staff hiring, work allocation and scheduling, training and professional development, performance management and related management activities.

Participate in the analysis, development, implementation and evaluation of the care management program and policies so that quality, documentation, policies and procedures are consistent with current federal and state regulations and applicable improvement.

Develop and maintain positive working relationships with external provider agencies.

Responsible for achievement of department initiatives for cost management in addition to the accuracy and effectiveness of the care management processes and work with the appropriate departments to improve their understanding of how these standards impact their departments.

Work closely with all appropriate internal departments to resolve complex issues related to care management and social management of members.

Work with Care Management staff to evaluate and assist in the appropriateness of plan of care and to collaborate with Care Management Team to get support and ideas to help manage member.

Participate in activities to monitor compliance with authorization policies, effectiveness of care plans and service provision guidelines, and their impact on outcomes.  Such activities may include, but not limited to, chart review, field audits peer review, metric reporting & focused reviews.

Other functions as required to support departmental activities

Regular and reliable attendance in departmental and other Integra meetings as requested is an essential function of the position.