Team Lead, Integrated Care - Post Acute

Job Summary:

The Team Lead, Integrated Care - Post Acute is responsible for providing direct oversight of Post-Acute Clinical employees and overseeing day-to-day workflow within the team.

Essential Functions:

• Provide direct oversight of post-acute department staff and oversee day-to-day workflow within the team

• Ensure all direct reports are performing at minimum quality and productivity standards or better

• Understand complexities of health conditions and services including HCBS enrollment and disenrollment processes, NF level of care, and market NF disenrollment processes

• Develop plan for management of workload after analyzing trends and act as advocate for the team

• Provide feedback, guidance, orientation, training and ongoing resources to team

• Standardize activity and outcome reporting for department initiatives and programs including documentation required by the State and accrediting bodies

• Responsible for utilization review, level of care review, HCBS waiver enrollment and disenrollment, and discharge planning activities for CareSource members

• Monitor and ensure appropriate delivery of healthcare services in cost-effective manner

• Assist manager and director in development of process improvement activities and refining of processes that facilitate cost-effective utilization and appropriate levels of care

• Support and facilitate collaboration with Care Management, Claims, Enrollment, Customer Service and other areas as needed to assist in problem resolutions

• Perform audits of team members to ensure compliance with CareSource policies, processes, regulatory requirements, NCQA utilization review guidelines and standards, and URAC review guidelines

• Provide input into direct report employee evaluations and assist with development of team goals

• Assist in the development of procedures, processes, and/or workflows to address regulatory and contractual requirements

• Provide education to team to ensure compliance with policies and procedures

• Design and present post-acute informational meetings as needed

• Responsible for attending state hearings as necessary

• Perform any other job duties as requested

Education and Experience:

• Nursing degree from an accredited nursing program is required

• Bachelor of Science degree in Nursing or equivalent years of relevant work experience is preferred

• Minimum of five (5) years clinical experience preferred

• One year of Utilization Management/Utilization Review experience required

• Managed care experience is preferred

• Certified Care Manager experience is preferred

Competencies, Knowledge and Skills:

• Basic computer skills

• Basic proficiency in Microsoft Word and Excel

• Communication skills

• Management skills

• Prior supervisory skills

• Ability to work independently and within a team environment

• Attention to detail

• Familiarity of the healthcare field

• Critical listening and thinking skills

• Training/teaching skills

• Negotiation skills/experience

• Proper grammar usage

• Time management skills

• Proper phone etiquette

• Customer service oriented

• Decision making/problem solving skills

• Leadership experience and skills

Licensure and Certification:

• Current, unrestricted licensure in state of practice as a Registered Nurse (RN) is required

• Multi-state licensure is preferred

• MCG certification is preferred

Working Conditions:

• General office environment; may be required to sit or stand for extended periods of time

• Weekend and holiday coverage required

Compensation Range:
$70,800.00 - $113,200.00 CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type:
Salary

Competencies:
- Create an Inclusive Environment
- Cultivate Partnerships
- Develop Self and Others
- Drive Execution
- Influence Others
- Pursue Personal Excellence
- Understand the Business

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an inclusive environment that welcomes and supports individuals of all backgrounds.

#LI-JM1