Universal American
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RN Case Management Supervisor - Telephonic

Job Title
RN Case Management Supervisor - Telephonic
Job ID
792382
Begin Date
4/2/14
Duration
Location
Syracuse,  NY
Other Location
Description
Universal American is a New York Stock Exchange company with annual revenues of more than $2 billion. Through our family of healthcare companies, we provide health benefits to people covered by Medicare and/or Medicaid. We are dedicated to working collaboratively with healthcare professionals in order to improve the health and well-being of those we serve and reduce healthcare costs. 

Well-capitalized and highly entrepreneurial, Universal American has been on the cutting edge of healthcare for more than 21 years. We offer Medicare Advantage plans to people with Medicare. We partner with providers in Accountable Care Organizations that serve people with Original Medicare. And we provide array of healthcare services to states, municipalities, health plans and other entities in the world of Medicaid. In everything we do, we focus on improving the coordination of healthcare through collaboration between payers, providers and patients to achieve the best health outcomes possible. 

For more information on Universal American, please visit our website at www.UniversalAmerican.com.

This program will provide intensive case management to the highest complexity/risk members as well as transition of care to all members transitioning from acute settings to sub-acute/home settings.

Our goal is to provide intensive care coordination, support and collaboration with members, care givers and providers for high risk populations. We will provide multiple health, functional, social and financial needs to assist with the prevention or decrease the worsening of members’ health condition.

Summary:
In accordance with UAC policies and procedures, the RN Case Management Supervisor (Telephonic) will be responsible for a team delivering case management and care coordination services to identified high risk patients such that UAC achieves its quality of care, cost and patient satisfaction goals. The Supervisor will oversee, lead and manage a team including case managers and support staff, and work closely with clinical consultants including nutritionists, pharmacists and palliative care specialist. In addition, the supervisor will assist in developing and implementing key strategies, workflows, and related quality and compliance activities to support the daily operation and delivery of care management services. The supervisor trains, evaluates and delegates work to the appropriate staff level and ensures delivery of care and service in alignment with federal and state regulatory requirements and scope of practice for clinical position. 
Critical measures of success are compliance with CMS and UAC policies, eliminating avoidable admissions, reducing ER visits and readmissions and achieving a high degree of medication adherence for all members assigned to supervisor’s team. 

Responsibilities:
•Supports staff in all of their care management activities.
•Ensures the responsible and professional delivery of comprehensive service and care delivery of the field case management including the facilitation of relationships with community resources.
•Provides daily operational oversight to the field team, including appropriate referral and caseload assignments in alignment with employee licensure, experience and capabilities.
•Improves team’s strategies around locating, engaging, assessing and managing assigned members.
•Continuously evaluates, reports and implements improvements to impact staff productivity and quality of performance through available telephony and medical management applications and supportive data analysis and outcomes reporting. 
•Monitors activity of care management team through monitoring efforts (e.g., bi-weekly ride along, case reviews, case audits, call monitoring, etc.).
•Develops strong working relationships with internal and external stakeholders, as well as, providers and community organizations. 
•Performs performance management reviews and HR oversight of assigned personnel.
•Promotes mission, vision and values of program. 
•Maintains professional licensure(s), certification(s), and completes required continuing education credits to support ongoing position requirements.
•Promotes and facilitates positive team atmosphere by demonstrating the ability to work within a team and support team efforts.
•Supervises the quality management programmatic activities that are the direct responsibility of the Care Management team.
•Assists in the achievement and ongoing maintenance of federal/state regulatory and accreditation requirements.
•Demonstrates and facilitates customer service excellence. 
•Primary responsibility for weekly interdisciplinary case reviews for the team. 
•Consult and work closely with the Medical Director regarding complex clinical issues.
•Comply with all departmental policies and procedures. 
•Participate in departmental and company in-services as appropriate. 
•Comply with Customer Service expectations as applicable to the Department and Health Plan.
•Complies with all guidelines established by the Centers for Medicare and Medicaid (CMS) and guidelines set forth by other regulatory agencies, where applicable, and defined in the Universal American Corporate and department policies.
•Must comply with company’s Immunization policy and procedure.
•And all other duties assigned by the manager and/or supervisor.

Required Skills
•Problem solving skills with the ability to look for root causes and implementable, workable solutions. “Go getter” approach essential
•Decision-making skills with the ability to investigate and weigh alternatives and select the course of action that provides the greatest benefit to the organization 
•Organizational skills with the ability to handle multiple tasks and/or projects at one time 
•Time management skills with the ability to prioritize and schedule daily activities for the most efficient use of time 
•Creative thinking skills with the ability to ask the needed bigger-picture questions that lead to process and team improvements 
•Interpersonal skills with the ability to work in a fast-paced environment and participate as an independent contributor with little supervision or as an active team member depending on the situation and needs 
•Professional verbal and written communication skills, with the ability to clearly articulate thoughts and ideas 
•Customer service skills with the ability to interact professionally and effectively with providers, third party payers, physicians, and staff from all departments within and outside the Company 
•Must have a track record of producing work that is highly accurate, demonstrates attention to detail, and reflects well on the organization

Required Experience
•RN with current unrestricted NYS licensure – required. 
•Bachelor's degree required.
•Minimum 2-3 years’ experience as a nursing manager – required.
•Minimum 3 years hands-on nursing experience required. 
•Work in clinical setting serving medically or socially complex patients preferred. Behavioral/mental health experience helpful.
•Previous experience in care management, disease management and/or case management preferred. 
•Public health nursing or home health background preferred.
•Experience working with Medicare / Medicaid/MLTC preferred.
•CCM and/or related certification or eligibility is a plus.
•Personal computer experience should include working with Microsoft Word, Excel, PowerPoint. 
and Outlook at the intermediate level at a minimum.
•Maintains a valid driver’s license for any required facility on-site and home visits.

Universal American Corp. is an Equal Opportunity / Affirmative Action Employer and does not discriminate because of age, color, disability, ethnicity, marital or family status, national origin, race, religion, sex, sexual orientation, military veteran status, or any other characteristic protected by law. We are committed to attracting, retaining and maximizing the performance of a diverse and inclusive workforce.
Required Skills

RN Case Management Supervisor Telephonic
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