As a part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide. We help our clients strengthen their financial and clinical performance, serve their communities and succeed at the business of healthcare. Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost and access to healthcare. Are you ready to be part of our solutions? Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step!
The Manager Case Management works under the direction of the Director of Medical Management. The Manager is responsible for the planning, directing, managing and evaluating all operational components for case and disease management. Case and disease management are processes within Medical Services that assist members with improving his/her quality of life. This position provides supervision and oversight to clinical and non-clinical staff. The Manager is responsible for implementing a collaborative process for case and disease management that includes assessing, planning, implementing, coordinating, monitoring follow up and evaluating the options and services required to meet an individualâ��s health needs. Other duties pertinent to the day to day operations of the department may be assigned as needed.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Include the following. Others may be assigned.
Provides oversight of operational components for case and disease management programs and provides leadership to clinical and non-clinical staff. Prepares annual program evaluations of case and disease management programs including strengths, weaknesses and opportunities and makes recommendations for change.
Annually reviews clinical and financial outcome data and makes recommendations as related to a ROI.
Development of appropriate work plans for case and disease management as appropriate and related to AHCCCS/CMS/NCQA.
Responsible for the timely submission of required AHCCCS/CMS reporting requirements as related to case and disease management.
Responsible for identification of program/process improvements for current case and disease management programs.
Responsible for implementation of case/disease management software and utilizing technology to the fullest at all levels.
Serves as a liaison between the Case Management Department and Quality Management Department.
Provides necessary reports to appropriate individuals.
Completes special projects as assigned.
Other duties as assigned.
If direct report positions are listed below, the following responsibilities will be performed in accordance with guidelines, policies and procedures and applicable laws. Supervisory responsibilities include interviewing, hiring, and training employees; planning, assigning and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems.
Direct Reports (titles) 3 - 6 +/- Supervisors, Leads and/or Case Management Staff
Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment activity. This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings.
KNOWLEDGE, SKILLS, ABILITIES
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Experience in Social Work, CM or other managed care environment.
Prior Supervisory/Management experience
Knowledge of disease specific states, clinical and community resources.
Strong critical thinking and problem solving skills.
Ability to network, advocate, communicate assertively with all customers.
Ability to work with high volume and strict timeframes.
Excellent communication skills.
Exceptional organizational skills especially while multitasking.
Ability to work in fast paced environment.
Works well independently as well as part of a team.
Strong commitment to help others.
Must have experience working with a Medical Management platform. MS Word, Excel, Outlook a plus
EDUCATION / EXPERIENCE
Include minimum education, technical training, and/or experience preferred to perform the job.
Minimum Education: LMSW or RN
Preferred Education: BA or BS in Nursing, MSW in Social Work
2+ years disease management, case management or formal patient education experience;
Experience working in/or managing in a managed care environment
Previous supervisory or management experience
5 years disease management, case management or formal patient education experience, supervisory experience;
2+ years management experience
5+ years of relevant health care experience, preferably in managed and/or long term care
Include minimum certification required to perform the job.
Licensure must be current and unrestricted in the appropriate jurisdiction
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Must be able to work in sitting position, use computer and answer telephone
Ability to travel
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Office Work Environment
Approximately 15% travel may be required
Job: Conifer Health Solutions
Primary Location: Westminster, California
Job Type: Full-time
Shift Type: Days
Employment practices will not be influenced or affected by an applicantâ��s or employeeâ��s race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship.
Tenet Healthcare Corporation (NYSE: THC) is a diversified healthcare services company headquartered in Dallas with 112,000 employees. Through an expansive care network that includes United Surgical Partners International, we operate 65 hospitals and approximately 510 other healthcare facilities, including surgical hospitals, ambulatory surgery centers, urgent care and imaging centers and other care sites and clinics. We also operate Conifer Health Solutions, which provides revenue cycle management and value-based care services to hospitals, health systems, physician practices, employers and other clients. Across the Tenet enterprise, we are united by our mission to deliver quality, compassionate care in the communities we serve.