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Director, Field Care Management-Louisville, KY

Company: WellCare
Location: Louisville
Posted on: February 15, 2020

Job Description:

Join us at WellCare to build a better career while helping our members lead better, healthier lives. Our leaders have a strong passion and a clear mission at WellCare. Wherever you work within the organization, you will know that you are part of a larger, noble mission, dedicated to enhancing our members health and quality of life. Here, you will find a culture of empowerment, teamwork and commitment as we all work together to deliver cost-effective solutions that create positive outcomes for our more than 6.0 million members. Director, Field Care Management Louisville, KY: Ensures the case management process of assessing, planning, implementation, coordination, monitoring, and evaluating services and outcomes is pursued to maximize the health of the member. Oversees the socio economic needs and services of selected member populations across the continuum of illness. Takes part in extensive community outreach to garner relationships with key stakeholder groups and organizations. Reports to: VP, Field Health Services, PHS - KY Care Management Department: Health Services Position located: Louisville, KY TBD Essential Functions: - Manages and develops direct reports who conduct both case management and social service functions within a member's care plan. - Sets operational priorities and manages resources to operational goals and budgets. - Proactively monitors appropriate metrics to drive up efficiency. - Directs the case management process, providing advice when necessary of complex, controversial and/or unique administrative processes, medical procedures and payment guidelines. - Establish, maintain and foster professional working relationships with all providers and community stakeholders. - Partners & collaborates with other departments cross functionally regarding care and case management and/or Health Service initiatives. - Manages & resolves e-mails and escalated phone issues in response to provider, staff and other department requests. - Directs work assignments, measures results and initiates personnel actions as required. - Participates in continuous quality improvement projects that involve case and social service components. - Ensure timely and complete delivery of required regulatory reports. - Serve on community advisory boards and task forces to address workforce and other long-term care challenges. - Ensures compliance with all state and federal regulations and guidelines for all lines of business. - Performs other duties as assigned. Additional Responsibilities: - Manages and develops direct reports who conduct both case management and social service functions within a member's care plan. - Sets operational priorities and manages resources to operational goals and budgets. - Proactively monitors appropriate metrics to drive up efficiency. - Directs the case management process, providing advice when necessary of complex, controversial and/or unique administrative processes, medical procedures and payment guidelines. - Establish, maintain and foster professional working relationships with all providers and community stakeholders. - Partners & collaborates with other departments cross functionally regarding care and case management and/or Health Service initiatives. - Manages & resolves e-mails and escalated phone issues in response to provider, staff and other department requests. - Directs work assignments, measures results and initiates personnel actions as required. - Participates in continuous quality improvement projects that involve case and social service components. - Ensure timely and complete delivery of required regulatory reports. - Serve on community advisory boards and task forces to address workforce and other long-term care challenges. - Ensures compliance with all state and federal regulations and guidelines for all lines of business. - Performs other duties as assigned. Candidate Education: - Required A Bachelor's Degree in Nursing, Health Administration or directly related field Candidate Experience: - Required 10 years of experience in current case management - Required 5 years of management experience - Required 5 years of experience in managed care - Required Other Associates supporting Florida's Children's Medical Services (CMS) will have a minimum on seven (7) years of experience in managed care or in a clinical setting, including at least two (2) years of managed care experience (preferably in Medicaid or CHIP) and at least five (5) years of experience working with children -AND- Knowledge of Florida child serving systems Candidate Skills: - Intermediate Ability to communicate and make recommendations to upper management - Intermediate Demonstrated time management and priority setting skills - Intermediate Ability to create, review and interpret treatment plans - Intermediate Ability to lead/manage others - Intermediate Demonstrated problem solving skills - Intermediate Demonstrated interpersonal/verbal communication skills - Intermediate Demonstrated negotiation skills - Intermediate Knowledge of community, state and federal laws and resources - Intermediate Demonstrated written communication skills - Intermediate Ability to effectively present information and respond to questions from families, members, and providers - Intermediate Ability to effectively present information and respond to questions from peers and management - Intermediate Knowledge of healthcare delivery - Intermediate Ability to lead/manage others in a matrixed environment - Intermediate Ability to implement process improvements - Advanced Other Strong clinical knowledge of broad range of medical practice specialties Licenses and Certifications: A license in one of the following is required: - Required Other Either a Licensed Registered Nurse (RN) or Licensed Clinical Social Worker (LCSW) license is required. - Preferred Certified Case Manager (CCM) - Required Other Maintain required contact hours to fulfill regulatory requirements - Required Other For IL, Special Needs Kids, candidate can be an independent licensed mental health professional, LCSW, LCPC, LMHC, LMFT, LPC etc - Required Other Associates supporting Florida's Children's Medical Services (CMS) must be a Florida licensed clinical professional Technical Skills: - Required Intermediate Microsoft Outlook - Required Intermediate Microsoft Word - Required Intermediate Microsoft Excel - Required Intermediate Microsoft PowerPoint - Required Intermediate Healthcare Management Systems (Generic) - Required Intermediate Microsoft Visio Languages: About us Headquartered in Tampa, Fla., WellCare Health Plans, Inc. (NYSE: WCG) focuses primarily on providing government-sponsored managed care services to families, children, seniors and individuals with complex medical needs primarily through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans, as well as individuals in the Health Insurance Marketplace. WellCare serves approximately 5.5 million members nationwide as of September 30, 2018. WellCare is a Fortune 500 company that employs nearly 12,000 associates across the country and was ranked a 'World's Most Admired Company' in 2018 by Fortune magazine. For more information about WellCare, please visit the company's website at . EOE: All qualified applicants shall receive consideration for employment without regard to race, color, religion, creed, age, sex, pregnancy, veteran status, marital status, sexual orientation, gender identity or expression, national origin, ancestry, disability, genetic information, childbirth or related medical condition or other legally protected basis protected by applicable federal or state law except where a bona fide occupational qualification applies. Comprehensive Health Management, Inc. is an equal opportunity employer, M/F/D/V/SO.

Keywords: WellCare, Louisville , Director, Field Care Management-Louisville, KY, Executive , Louisville, Kentucky

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