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RN Supervisor, Complex Case Management
ConnectiCare is a leading health plan in the state of Connecticut. A local company for more than 35 years, ConnectiCare has a full range of products and services for businesses, municipalities, individuals and those who are Medicare-eligible. By striving to make it easy for members to get the care they need, ConnectiCare leads the individual market in the state, and is ranked among the top commercial health plans in the nation, according to the National Committee for Quality Assurance. ConnectiCare is a subsidiary of EmblemHealth.
We’re looking for individuals who want to make a difference in the communities we serve. If you want to join a local team and help change the way health care is delivered, ConnectiCare is the place for you.
Summary of Job: Support the integration of care and utilization management to Total Population Health holistic model of care, characterized by multi-disciplinary and provider collaboration alignment, innovative clinical programs and practices to achieve the triple aim (Population Health, Member Experience, Per Capita Cost) through care and disease management processes.
- Under the direction of the Director, is responsible for the execution of efficient departmental processes designed to manage inpatient and outpatient utilization and quality of care within the benefit plan.
- Contributes to the overall success of Total Population Health by promoting /advancing the department mission of effectively facilitating care and improving outcomes at all points along the health care continuum, from preventive health and wellness through chronic care management to end of life care in all health care settings.
- Actively collaborates with other Total Population Health Supervisors and delegates/vendors to promote integration of processes and workflows across teams and eliminate duplication.
- Acts as a coach and mentor to staff to ensure understanding of utilization, disease and complex care management concepts and effectively apply the concepts to managing members’ health care needs.
- Acts as a coach and mentor to staff to ensure compliance with ConnectiCare, State, Federal and NCQA requirements related to utilization and care management activities.
- Under the direction of the Director; supervises, trains, evaluates and develops assigned staff.
- Develops, monitors, and communicates performance expectations and plans for all direct reports and conducts performance reviews within specified timeframe. Provides feedback on a regular basis. Assists with resolution of employee performance issues.
- Completes monthly telephone audits of staff using Virtual Observer technology and provides feedback to staff. Tracks audit results toward performance objectives
- Tracks and reports statistics on care management and/or utilization management activities, process measures (e.g. timeliness), quality results, and other measures that affect departmental objectives.
- Facilitates staff’s engagement with provider collaboration arrangements, and other physician organizations in the management of their attributed members.
- Maintains an environment of quality improvement through continuous evaluation of processes and policies. Identifies and recommends new technologies and process efficiencies.
- Interacts with various departments throughout ConnectiCare and contributes to the resolution of interdepartmental issues. Leads and develops team to quickly assess and diagnose root causes to problem areas.
- Actively participates on assigned committees and projects.
- Performs duties of a care manager or utilization manager as needed.
- Performs other duties as assigned.
- RN, licensed in Connecticut. Bachelor’s Degree in Nursing, health care, or business, or an equivalent combination of education and experience.
- At least 2 years of managed care experience preferred.
- At least 5 years of clinical experience required; supervisory experience preferred.
- State of the art knowledge of care management scope of practice.
- Strong oral and written communication and interpersonal skills.
- Strong organizational skills.
- Strong knowledge of Microsoft Office products including Word, Excel, and Access.
Essential Job Functions:
- Primarily sedentary
- Must be able to use standard office equipment