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Clinical Manager for Case Management | Care Coordination

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Location
Milwaukee, WI
Job Type
Direct Hire
Degree
Bachelor
Date
Jan 15, 2019
Job ID
2645674

Clinical Manager for Case Management | Care Coordination – MILWAUKEE Health Plan


Manage and develop clinical team of licensed medical and behavioral health clinicians, ensuring quality of care for individuals with both behavioral health and medical conditions.  This team has oversight for the Case Management and Care Coordination services and activities for members. 
 

  • Manage clinical services including oversight of clinical policies and procedures and daily activities of integrated care coordination team staff.
  • Ensure adequate staffing to conduct case management activities and effectively distribute workloads.
  • Ensure team members receive appropriate training to serve the population and demonstrate effective engagement activities for individuals with various disabilities including chronic physical and behavioral health conditions.
  • Ensure Integrated Clinical Services staff are trained on NCQA and HEDIS measures and processes to ensure compliance.
  • Ensure all programs and clinical operations are in full compliance with state and federal regulations, including HIPAA.
  • Ensure compliance with plan’s emergency management policies, procedures and processes by acting as liaison with other business units.
  • Monitor the effectiveness of existing procedures and outreach/intervention efforts in demonstrating positive outcomes for members.
  • Ensure appropriate case planning, education and interventions are conducted for members defined to be at risk.
  • Ensure staff coordinate exchange of information between behavioral health and medical providers in developing comprehensive care plans for at-risk members.
  • Monitor data to address quality measures, trends or potential improvement opportunities including provider issues, service gaps and member needs. 

Qualifications 
 

  • Bachelor’s degree or Graduate from an Accredited School of Nursing
  • Licensure as an RN or in social services: LCSW, LMFT or LPC, or a PhD, PsyD or RN
  • 3+ years case and/or utilization management experience.
  • Thorough knowledge in assessment, diagnosis, treatment of individuals with serious mental health or substance abuse disorders, case management, mental health community resources and local health delivery systems
  • Previous experience in a leadership role, managing cross functional teams on large scale projects or supervisory experience including hiring, training, assigning work and managing the performance of staff.