Job Title:

Health Plan Team Manager

Description

Determine the Consumer’s needs in receiving LTSS services by adhering to the State mandated processes. The PCC Service Coordinator Team Lead supports the participants and supervises their assigned Aging Team to assist participants in receiving LTSS services.

PCC serves the following waivers and programs in Pennsylvania:

• Aging Waiver
• COMMCARE Waiver
• Attendant Care Waiver
• Independence Waiver
• Act 150 Program
• NHT for Special Funds
• OBRA Waiver
• Community HealthChoices Waiver

PCC offers Pennsylvania Home and Community Based Services (HCBS) services for the following:

• Case Management service and care coordination, including arranging appointments and referrrals to community resources
• Case management plan development, with person-centered goals
• Self-management plan development and monitoring
• Self-directed services
• Personal care assistance services
• Housekeeping and chore services
• Financial management
• Housing-related services
• Personal Emergency Response Systems (PERS)
• Adult day living services
• Non-Medical transportation
• Home modifications
• Respite services
• Home health
• Accessibility adaptations, equipment, technology and medical supplies
• Pest Eradication

Our Philosophy

Patient Care Coordination is committed to enhancing the quality of life of our consumers by providing a well-rounded, focused and consumer-approached level of service. Our consumer-approached focus enables Patient Care Coordination to provide consumers with the proper and most appropriate types of services to enable independence in the community.

Overall Responsibilities:

Under the supervision of the Chief Operations Officer, the Health Plan Team Manager is responsible for the development and coordination of services for an assigned managed care organization. The SC Health Plan Team Manager will supervise and provide consultation to designated Service Coordinator team members.

Job Responsibilities for MCO Team Manager

1. Responsible for the operational functions of the service coordinator team assigned to a designated LTSS CHC health plan MCO.

2. Support and supervise staff providing day-to-day supervision, including direct administrative and clinical supervision (if applicable based on licensure)

3. Establishes and maintains production and quality standards by developing and ensuring compliance with all customer service and process standards through reviews, monitoring audits, reports and practices. Provides direct and timely feedback to all staff on the results.

4. Ensure all service coordination responsibilities are completed in compliance with MCO specific contract requirements including participant assessments and person- centered service plans.

5. Stays up to date with all CHC waiver changes and MCO changes and training then ensures all Service Coordinators on their team are trained on changes.

6. Acts as main point of contact and mentor for training; ensures required trainings and educational needs of staff are met during initial orientation and at least annually per CHC agreement requirements and OLTL standards; Follows training guidelines and offers in-service support on an ongoing basis.

7. Collaborate closely and develop strong working relationship with assigned MCO internal service coordination team; Maintains a high level of customer service and responsiveness to the health plan; instill a positive image of PCC at the designated health plan and with partner organizations and throughout community.

8. Ensures accurate and timely documentation of all services provided and other related paperwork per PCC contract with the MCO and CHC Agreement requirements.

9. Coordinate intake of participants accepted by PCC and ensure documentation and permissions are reviewed and signatures obtained for delivery of services, choice of providers and participants rights and responsibilities.

10. Monitor productivity and quality of team to ensure PCC standards are maintained; Maintains appropriate tracking of department statistics based on organizational and regulatory standards to ensure compliance with OLTL and NCQA requirements as well as MCO quality standards.

11. Review team’s performance against established company goals and OLTL guidelines: Identify problems and initiate a corrective action plan as needed

12. Schedules routine coaching interactions with the service coordinators on the team to drive performance expectations; Completes performance evaluations and adheres to established performance evaluation timeframes

13. May be responsible for a caseload of individual participants; Maintains and exceeds daily, weekly, and monthly billing requirements per the billable unit standards currently established for team managers as well as adhering to the highest quality standards for service coordination delivery to assigned participants.

14. Assists and audits service coordination visits and monitoring calls and maintain compliance and integrity of participant care while ensuring high levels of customer satisfaction.

15. Coordinates and conducts department meetings on a regular basis; attends all other regularly scheduled staff meetings

16. Provide the best customer care possible, including reliability in working scheduled hours; Takes the lead in handling all crisis situations and provides solutions and direction to team members to help problem solve and clear barriers to effectively meeting the needs of our participants and MCO partners in person centered care planning.

17. Create an organizational culture that respects and celebrates the diversity of our participants; maintain a participant-focused level of practice that adheres to the company’s mission and values, and per OLTL regulations.

18. Perform other duties as assigned.

Qualifications

• Bachelor's degree required (social services or human services field preferred); Master’s degree preferred. 12 credit hours must be in a social services/human services field, at a minimum in conjunction with bachelors
• Strong knowledge of MCO software is desirable
• Knowledgeable on CHC Waiver
• Solid understanding of MCO model and expectations
• Ability to learn new systems and then effectively train others
• Strong critical thinking and problem-solving skills
• Ability to act as a liaison between PCC and MCO
• Proficient in MS Office applications with emphasis on Excel
• Ability to organize multiple tasks in a timely manner
• Travel throughout Philadelphia and/or surrounding counties is required up to 30% per week
• 3 years’ experience in human services/case management is preferred
• Previous supervisory experience required unless waived by management
• Ability to guide and mentor staff and encourage high levels of quality and productivity
• Motivate staff and colleagues in acquiring goals and maintaining high levels of quality output

Job Type: Full-time

Pay: $48,000.00 - $60,000.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Experience level:

• 5 years

Schedule:

• Monday to Friday

Education:

• Bachelor's (Preferred)

Experience:

• Management: 5 years (Required)
• ELTSS: 1 year (Required)

Work Location: In person