Care Management Clinician Team Lead
PacificSource

Boise, Idaho

Posted in Insurance


This job has expired.

Job Info


Looking for a way to make an impact and help people?

Join PacificSource and help our members access quality, affordable care!

PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.

Diversity and Inclusion: PacificSource values the diversity of the people we hire and serve. We are committed to creating a diverse environment and fostering a workplace in which individual differences are appreciated, respected and responded to in ways that fully develop and utilize each person's talents and strengths.

Accountable for the effective management of the Clinical Care Managers for all lines or assigned lines of business. Responsible for hiring, training, coaching, counseling, and evaluating team member performance. May be called upon to perform routine day-to-day program functions. Actively participate in program development and implementation. Supervise and provide guidance to direct reports and other department staff regarding company policies, procedures, and operations. Manage the quality and productivity of team tasks and workflow as they relate to both assigned functions and the overall effectiveness of the Health Services team. Work to resolve issues and improve processes and outcomes.

Essential Responsibilities:

  • Take a leadership role in the development, implementation, and ongoing operation and maintenance of assigned programs, services, or functions.
  • Improve the performance of the department through effective oversight and coaching of team members, managing team performance and improving processes and outcomes. Monitor daily workflow and caseloads and other work processes of team to assure appropriate distribution and processing of tasks.
  • Responsible for the orientation and training of new hires.
  • Provide ongoing supervision, training, evaluation, and leadership to assigned team members. This may include annual reviews, involvement in promotions and/or terminations of employees.
  • Participate in hiring decisions in concert with Director and/or Health Services Manager and Human Resources.
  • Monitor, evaluate and take action on team assignments relating to volume, timelines, accuracy, customer service, and other quality and performance measures as appropriate.
  • Assist with process improvement and work with other departments to improve interdepartmental processes. Utilize lean methodologies for continuous improvement. Utilize visual boards to monitor key performance indicators and identify improvement opportunities.
  • Serve as liaison with other PacificSource departments or community partners to coordinate optimal provision of service and information. Serve on various internal and external committees as required or designated. Document and report any pertinent communications back to the team or department.
  • Utilize and promote use of evidence-based tools.
  • Maintain modified caseload consistent with assigned responsibilities.
  • Facilitate investigation and resolution of process-related issues as needed. Facilitate conflict resolution, including interfacing with affected departments and individuals, as appropriate.
  • Oversee and assist in providing exceptional service and information to members, providers, employers, agents, and other external and internal customers.
  • Practices and models effective communication skills; both written and verbal.
  • Provide backup to other departmental teams or management staff, as needed.

Supporting Responsibilities:
  • Meet department and company performance and attendance expectations.
  • Relate new or revised policies, procedures and/or processes to team members to ensure they have the most up-to-date and current information.
  • Facilitate team operations by discussions through the sharing of information and knowledge, identification of teamwork issues, development of problem-solving recommendations, and recommendations of standardizing Health Services operations.
  • Represent the Heath Services Department, both internally and externally, as requested by Health Services Manager and/or Director.
  • Perform other duties as assigned.

SUCCESS PROFILE

Work Experience:

A minimum of five years clinical experience, including case management experience required. Minimum of three years direct health plan experience in the following areas: case management, utilization management, behavioral health, and/or disease/condition management strongly preferred. Prior supervisory experience preferred.

Education, Certificates, Licenses:

Registered Nurse or Licensed Clinical Social Worker or Licensed Professional Counselor or Licensed Marriage and Family Therapist (LMFT) with current appropriate unrestricted state license. Certified Case Manager Certification (CCM) as accredited by CCMC (The Commission for Case Management) strongly desired at time of hire. CCM certification required within two years of hire.

Knowledge:

Knowledge of health insurance and state mandated benefits. Thorough knowledge, experience and expertise in case management practice including; advocacy, assessment, planning, communication, education, resource management, and service facilitation. Effective adult education/teaching and/or group leadership skills. Ability to deal effectively with people who have various health issues and concerns. Strong analytical and organizational skills with experience in using information systems and computer applications. Demonstrates flexibility. Ability to develop, review, and evaluate utilization and case management reports. Strong computer skills including experience with Word, Excel, and PowerPoint. Ability to use audio-visual equipment. Ability to work independently with minimal supervision.

Competencies:

Building Trust

Building a Successful Team

Aligning Performance for Success

Building Customer Loyalty

Building Strategic Work Relationships

Continuous Improvement

Decision Making

Facilitating Change

Leveraging Diversity

Driving for Results

Environment:

Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 5% of the time.

Skills:
Accountable leadership, Collaboration, Communication (written/verbal), Critical Thinking, Decision Making, Influencing, Listening (active), Organizational skills/Planning and Organization

Our Values

We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business:
  • We are committed to doing the right thing.
  • We are one team working toward a common goal.
  • We are each responsible for customer service.
  • We practice open communication at all levels of the company to foster individual, team and company growth.
  • We actively participate in efforts to improve our many communities-internally and externally.
  • We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community.
  • We encourage creativity, innovation, and the pursuit of excellence.

Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.

Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.


This job has expired.

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