Experience Inc. Jobs

Duties/Responsibilities:

• Develops and monitors team goals; provides ongoing feedback and coaching; conducts annual performance reviews; leads by example; routinely evaluates staffs clinical skills and technical comprehension; and ensures an atmosphere of open communication, teamwork, and empowerment to make informed decisions

• Maintains and recommends appropriate staffing levels to guarantee safe and effective care management

• Oversees continuation, coordination, and delivery of individualized care plans and authorized services

• Collaborates with each Clinical Operations core areas as needed

• Assists in analyzing reviews, metric data, and PHI audits and uses that information to identify opportunities for improvement

• Additional duties as assigned

Minimum Qualifications:

• For Medical Care Management:

• Associates degree

• NYS RN

• LCSW or LMSW (any state)

Preferred Qualifications:

• CCM certification

• Supervisory or training experience

• Relevant clinical work experience

• Knowledge of member satisfaction/incident management and regulations

• Knowledge of quality improvement methodologies

• Demonstrated professionalism and leadership skills along with ability to develop, direct, and support a team

• Work experience collaborating with multiple stakeholders to secure appropriate care

• Time management, critical/creative thinking, communication, and problem-solving skills

• Work experience simultaneously navigating the internet and multi-tasking with multiple electronic documentation systems

• Adept at planning, organizing, and executing

• Knowledge of health insurance, Medicaid, Medicare and MLTCP

• Care management experience in a clinical managed care environment and knowledge of best practices

• Work experience requiring the ability to relate well with members, their families and community care providers, along with demonstrated ability to handling rapidly changing crisis situations

• Knowledge of UM/QM case philosophies and reporting requirements to state and federal agencies

• Ability to allocate, monitor, and control resources while delegating and monitoring workloads

• Ability to effectively manage performance as well as set and achieve goals

Compliance & Regulatory Responsibilities:

• Ensures Care Management team meets department and regulatory requirements

• Guarantees care plans are revised and updated according to regulatory requirements and as a members condition(s) changes in the multiple PHI databases, especially TruCare. Supervises and audits compliance including HIPAA standards, for confidentiality and management of PHI plus Care Management Team entries in varied electronic PHI storage systems (e.g.: Macess, TruCare, and EMR).

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.