Senior Manager, Care Management
Years of Experience
Comagine Health is looking for 2 remote Senior Manager - Care Management positions based in Oregon (applicants from the Southwestern region of Washington may also be considered). In this role, you will provide operational management of clinical and/or non-clinical staff who provide care management services. You will develop, implement, and maintain departmental policies and procedures, staffing protocols, training programs, quality management programs, and department budgets. You will ensure that the department fully meets all required legal, contractual and accreditation standards as well as compliance with corporate policies. Participate in business/product development, proposals, and customer relations activities. In conjunction with the Director and other managers, serve as a primary point of contact for the client regarding day-to-day operations and review issues based on area of clinical expertise. You will get to screen, interview and hire employees as needed. You will be responsible for the appeal review process, serving as main point of contact for providers, clients, and appeal reviewers and will ensure daily/weekly/monthly error and exception reports are processed in a timely manner. You may also conduct prospective, concurrent, and/or retrospective utilization management reviews. If this sounds like a role you’d be interested in, we encourage you to read on and apply!
Who is the Comagine Health?
Comagine Health is a non-profit consulting firm that seeks to improve health and to increase the effectiveness and quality of health care. As a recognized Quality Improvement Organization (QIO), we support providers, plans, purchasers, and consumers, and offer services to state and federal agencies and others to help them better manage health care under the existing system and to assess, plan for and implement broader system transformation. We collaborate with academic, government, and nonprofit partners on initiatives funded by NIH, CDC, AHRQ, BJA, SAMHSA, and others. In short, we are changing healthcare at a fundamental level.
What you’ll be doing for us:
Ensures the integrity and high quality of utilization and case management services:
- Accept utilization and case management assignments when work volumes or case complexities require managerial back up.
- Collaborate with the development and implementation of a quality management program, including an on- going internal quality control (IQC) system that provides on-going performance monitoring for compliance with contractual requirements, performance measures accreditation standards.
- Collaborate with medical affairs and staff in developing guidelines and protocols for case manager/clinical reviewer staff in referring, consulting, and staffing cases/reviews with Medical Directors and physician/practitioner consultants.
- Develop and implement, through collaboration with staff and other managers, the necessary operational policies, and procedures to meet contractual requirements, customer expectations, accreditation standards, and organizational needs.
- Monitor and maintain adequate access by providers, customers, patients/clients, and others with staff to provide the timely provision of case management services.
- Review case reports, appeal letters, and other sensitive documents to ensure they meet contractual requirements, accreditation standards, performance measures, timeframe requirements, and service standards.
Efficiently and effectively manages financial responsibilities:
- Develop and monitors the productivity standards for the staff to ensure there is efficient and effective delivery of services by the appropriate number and skill level of staff.
- Develop timely and appropriate budgets that include sufficient staffing and other resources to meet the contractual requirements, case/review volumes, service standards, and organizational goals
- Ensure compliance with finance and accounting policies and procedures, which includes but is not limited to the delegations of authority.
- Initiate timely and appropriate managerial interventions to improve compliance with the budget when expenditures are not in line with budget.
- Monitor unbilled hours and open cases/reviews to ensure that there is timely, accurate, and appropriate billing by staff if required by contract.
Effectively works with customers, including business development activities:
- Participate in responses to requests for proposals (RFPs), product development, and other business.
- Promote, monitor, and improve positive customer service behaviors, communications, and attitudes by all staff in the provision of services to all stakeholders.
- Provide timely, appropriate, and responsive communications and interventions, when necessary, with providers, patients/clients, customers, and other stakeholders to resolve their concerns, questions, and issues.
- Represent the products/services of the department through the active participation in customer conference calls, customer meetings, and educational seminars.
Comply with policies and procedures, administrative assignments, and other projects:
- Develop, monitor, and report on departmental goals, standards, and objectives through collaboration with the Vice President, Medical Director, staff, and other managers.
- Ensure that the management is informed in a timely manner regarding significant operational issues, performance measures, complaints/grievances, compliments, quality management initiatives, staffing concerns, and other relevant topics.
- Maintain compliance with organizational policies and procedures, including but is not limited to the strategic plan, organizational structure, confidentiality, safety, and complaint/grievance resolution.
- Monitor completion of timecards to ensure staff's accuracy, timeliness, and compliance with related policies and procedures.
- Provide timely, continuous recognition and feedback using objective, job-related data and observations (including documented performance appraisals at least annually); timely initiates performance improvement opportunities in alignment with Comagine Health policy and practice.
- Develop and monitor professional development goals and objectives; assign work and delegates authority appropriate for established, job-related duties, responsibilities, and qualifications.
- Develop, maintain, and enforce individual- and team-level performance expectations for deliverables; apply Comagine Health’s general conduct standards.
- Deliver, or ensure delivery, of initial orientation and training (including review of direct reports’ job descriptions), plus on-going training.
- Ensure availability of procedures, technology, and other resources necessary to conduct work activities; provide subject matter expertise as applicable.
- Conduct a variety of personnel management activities, including but not limited to recruitment, selection, on-boarding, training, evaluation, and separation, according to Comagine Health policy and practice and in collaboration with leadership and Human Resources.
- Master’s degree in a related field.
- Must meet the requirement for a Qualified Mental Health Professional (QMHP)
- Have or ability to obtain a QMHP-R within 2 weeks of employment (AND)
- Completion of QMHP-C within timeframe established by MHACBO.
- Active QMHP-C.
- Active Oregon Licensure (i.e., LPC, LMFT, LCSW, or Licensed Psychologist).
- 5 years of care management work experience.
- 5 years of clinical practice required for senior managers with a responsibility for managing licensed clinical staff.
- 3 years of management or supervisory work experience which includes responsibility for hiring, evaluating and termination.
Applicants must reside in the state of Oregon to be considered. Applicants from the Southwestern region of Washington may also be considered. Travel requirements are to be determined, but may include up to 25% if applicable, depending on business needs.
- Licensed Clinical Social Worker (LCSW).
- Licensed Professional Counselor (LPC).
- Licensed Psychologist.
- Licensed Marriage and Family Therapist (LMFT).
Salary Range: $102,000 - $125,000
The salary range posted reflects the range that Comagine is willing to pay for this position. Salary is determined by many factors, including but not limited to geographic location of where the employee will perform their job duties in addition to their knowledge, skills, education, and relevant work experience.
We offer competitive pay and benefits. Additionally, employment with Comagine Health qualifies if you apply for the Public Service Loan Forgiveness (PSLF) Program!
This position is located in Remote, OR. View the Google Map in full screen.