Manager

• Manages the care management team and the care coordination of behavioral health members to develop and assess high quality, cost-effective healthcare outcomes related to mental and behavioral health needs
• Manages escalations and care management issues related to members or providers
• Oversees and reviews care management required documentation to maintain compliance with federal and state regulations and contractual agreements
• Develops, implements, and oversees care management policies and procedures within the care management team based on regulatory requirements and industry standards
• Directs the daily activities of care management staff including reviewing and approving the caseloads of care management staff based on state requirements, care management staff experience, and member needs
• Manages escalated and complex care cases, and provides guidance to team members to address member concerns related to mental and behavioral health members
• Manages resolutions of complaints and assists in audits and evaluations related to care programs
• Develops, implements, and oversees care management programs to facilitate the use of appropriate services and resources
• Sets goals and objectives for care management team to achieve cost-effective healthcare results
• Works with care management senior management to provide updates and insights on care management team goals
• Provides feedback to care management team to improve member and provider experience and high-quality care
• Educates and provides resources for care management team on key initiatives and member outreach to facilitate on-going communication between care management team, members, and providers
• Assists care management senior leadership with onboarding, hiring, and training new care management employees, recent promotes, and transfers within the department
• Performs other duties as assigned

Manager, Care Management

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