This supervisory position is responsible for the oversight and management of daily operations related to the Case & Disease Management (CM/DM) area under the direction of the Manager of CM/DM. Interacts directly with Plan Medical Directors, CM/DM Staff, Utilization Management Staff , providers and members. Regularly and customarily exercise discretionary powers and independent judgment that directly supports the management of CM/DM activities.
Essential Job Duties:
Responsible for daily CM/DM operations, which includes triage of referrals to case and disease management programs, application of member benefits and DHP policies and business processes
Ensure adherence to CM/DM and Care Management departmental policies
Develop and review policies, procedures and statistical information necessary for case and disease management program activities
Responsible for interviewing, orienting, training, mentoring and work performance evaluations for assigned CM/DM staff.
Oversee CM/DM staffing and productivity, adjusting staffing patterns to provide adequate coverage for case and disease management operations during absences and with vacancies
Performs CM/DM activities to a specified population
In conjunction with the CM/DM Manager, develops and executes corrective actions or disciplinary measures necessary to improve staff performance.
Assist with the development and maintenance of CM/DM programs; and adherence of CM/DM programs and processes to NCQA, CMSA Case Management Standards and other applicable government regulations and quality initiatives
Ensure CM/DM team meets performance metrics and work plan requirements; Collaborates with the Manager of CM/DM to develop tools to meet strategic goals
Conduct projects and participates in team activities to identify problems and improve work processes and systems. Reviews and evaluates staff participation, individually and as a team member, on projects to identify problems and improve work processes and systems.
Acts as a leader and a resource to the CM/DM staff; work collaboratively and support the efforts of team members
Assist and participate in meeting company and department goals such as quality improvement activities
Promotes timely and effective communication based on individual and/or situational requirements and utilizes appropriate means to ensure adequate information flow
Duties as assigned by CM/DM Manager, Medical Directors and/or Director of Care Management
Graduate of an accredited school of Nursing
Bachelor's Degree in Nursing or related health care field
Minimum 5 years clinical experience in an acute care hospital, long term care facility, clinic or physician practice setting; minimum
Minimum of 2 years experience as a case manager
Excellent verbal and written skills
Perform tasks under only general or minimal supervision
Must have strong organizational, communication and leadership skills with the ability to manage multiple priorities
Experience in active problem solving and process improvement
Registered Nurse with an unrestricted license to practice within the State of Wisconsin or eligible for unrestricted licensure in Wisconsin; maintaining active, unrestricted professional licensure is a condition of continued employment.
Current CCM certification
Previous supervisory experience
Experience with NCQA or other quality certification programs
You’ve known us as many names throughout St. Louis, and now, we’re bringing our hospitals, doctors, home care and other services together under one name – SSM Health. With seven hospitals, 350+ physicians, more than 40 physician locations and 12,000 employees, we are part of something bigger and better. We’re connected to a wealth of resources, expertise and advance technology to help you, your fa...mily and our community live long, healthy lives.
We’ve grown and changed a lot over our 143-year history. Our name may be changing but our mission remains the same