Care Management Clinician – Team Lead
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Job Description
Care Management Clinician Team Lead supervising clinical care managers and improving Health Services programs. Supporting PacificSource members’ access to quality, affordable health insurance care.
Responsibilities:
- Manage Clinical Care Managers for assigned lines of business
- Hire, train, coach, counsel, and evaluate team member performance
- Perform routine day-to-day program functions as needed
- Participate in program development and implementation
- Supervise and guide direct reports and department staff on company policies, procedures, and operations
- Manage team task quality, productivity, workflow, and overall Health Services effectiveness
- Resolve issues and improve processes and outcomes
- Lead development, implementation, operation, and maintenance of assigned programs, services, or functions
- Monitor daily workflow, caseloads, task distribution, and processing
- Orient and train new hires
- Provide ongoing supervision, training, evaluation, and leadership, including annual reviews and involvement in promotions or terminations
- Participate in hiring decisions with leadership and Human Resources
- Monitor team assignments for volume, timelines, accuracy, customer service, and quality measures
- Support process improvement using lean methodologies, visual boards, and key performance indicators
- Liaise with PacificSource departments and community partners to coordinate services and information
- Serve on internal and external committees and report pertinent communications
- Promote use of evidence-based tools
- Maintain a modified caseload
- Investigate and resolve process-related issues and facilitate conflict resolution
- Oversee and assist with service and information for members, providers, employers, agents, and other customers
- Provide backup to departmental teams or management staff
- Communicate policy, procedure, and process updates to team members
- Facilitate team operations through information sharing, problem-solving, and standardization of Health Services operations
- Represent the Health Services Department internally and externally
- Perform other duties as assigned
Requirements:
- Minimum of five years clinical experience, including case management experience
- Minimum of three years direct health plan experience in case management, utilization management, behavioral health, and/or disease/condition management strongly preferred
- Prior supervisory experience preferred
- Active, unrestricted Registered Nurse (RN) license, Licensed Professional Counselor (LPC), Licensed Marriage and Family Therapist (LMFT), or Licensed Clinical Social Worker (LCSW) credential required
- Certified Case Manager Certification (CCM) accredited by CCMC required at time of hire or within two years of hire date
- Knowledge of health insurance and state mandated benefits
- Thorough knowledge and experience 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 work with people who have various health issues and concerns
- Strong analytical and organizational skills with experience using information systems and computer applications
- Ability to develop, review, and evaluate utilization and case management reports
- Strong computer skills including Word, Excel, and PowerPoint
- Ability to use audio-visual equipment
- Ability to work independently with minimal supervision
- Skills in accountable leadership, collaboration, written/verbal communication, critical thinking, decision making, influencing, active listening, organizational skills, planning and organization
- Ability to read and comprehend written and spoken English
- Ability to communicate clearly and effectively
- Ability to stoop and bend, sit and/or stand for extended periods, perform repetitive typing/sorting/filing motions, and lift/carry files and business materials
Benefits:
- Equal opportunity employment
- Work inside a general office setting with ergonomically configured equipment
- Travel approximately 5% of the time
- Company values and culture focused on teamwork, customer service, open communication, community improvement, social justice, equity, diversity and inclusion, creativity, innovation, and excellence
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