Minimum Education
Bachelor's Degree Nursing, Social Work, Health Services (Required)
Master's Degree Nursing, Social Work, Health Services (Preferred)
Minimum Work Experience
3 years progressive supervisory experience preferred (Preferred)
3 years of related experience in managed care and /or care management preferred (Preferred)
Required Skills/Knowledge
Understanding of Medicaid benefits
Excellent verbal and written communication skills
Familiarity with computer systems and applications. Computer literate in Microsoft suite
Strong organizational skills
Ability to interpret and apply departmental requirements
Ability to make sound decisions and use good judgment
Must be able to work under pressure and meet deadlines, while maintaining a positive attitude and providing exemplary customer service
Ability to work independently and to carry out assignments to completion within parameters of instructions given, prescribed routines, and standard accepted practice
Required Licenses and Certifications
Ind. Clinical Social Worker Licensed in District of Columbia Upon Hire (Required) Or
Registered Nurse Licensed in District of Columbia Upon Hire (Required) Certification in Case Management (Preferred)
Job Functions
Essential job duties:

• Responsible for day to day operations of an assigned team

• Responsible for a team of up to 12 licensed and unlicensed care management staff

• Reviews cases regularly with staff; acts as a clinical consultant regarding care management issues; guides clinical staff with review of assessments and care plans, evaluates utilization reviews and/or documentation

• Assists Associate Directors and Director in establishing, implementing, and ensuring care management policies, practices, and procedures are in place

• In conjunction with the Associate Directors and Director, coordinates, develops and implements action plan to respond to areas of need

• Leads and offers expert guidance and direct supervision to the team in aspects of care management: assessment, planning and implementation, coordination

• Assist the team with monitoring, and evaluation of options and services to meet the routine and complex health and behavioral health care needs of members

• Monitors work performed by team members according to organization, department and community standards

• Monitors productivity through the use of various reports to support appropriate outcomes and assign corrective action plans to staff as needed for immediate review and resolution

• Conducts regular team meetings in accordance with contractual agreement and as needed

• Responsible to complete all annual performance reviews for assigned staff

• Applies advanced problem-solving and analytical skills to evaluate and address complex situations involving members, providers, staff and community professionals

• Submits routine and special reports as assigned or requested.

• Participates in internal and external multidisciplinary team meetings.

• Attends/conducts meetings internally or externally with other government agencies or community organizations involved with enrollees in the health plan as needed

• Conducts weekly/bi-weekly supervision with assigned staff

• Responsible for oversight of assigned staff in maintaining caseload and contractual compliance metrics

Supervisory Care Manager (Special Populations):

• The responsibilities of the Care Management staff assigned to these populations are inclusive of the duties outlined above with further detail in their respective program description and/or policy.

Other job duties:

• May perform other duties in addition to those outlined in this job description

Organizational Accountabilities
Organizational Accountabilities (Managers)
Leadership Excellence

• Demonstrates understanding of quality of service and collaborates with co-workers to ensure excellence is achieved

• Innovates through improvement of care and/or efficiency of operational processes.

• Dedicated to a standard of performance excellence and high quality

Collaboration

• Creates a safe environment that encourages brainstorming, creativity and “out-of-the-box” thinking

• Encourages a diverse group of people to communicate effectively and embrace creative thinking

• Drives the collaborative efforts of the team to achieve goals in the most effective and efficient way

• Demonstrates listening and feedback skills

Leadership Skills

• Proactively assumes responsibility and accountability for results to include management of organizational change

• Empowers staff in ensuring a culture of transparency, fairness, respect and excellence

• Strategically aligns operational and tactical objectives to drive business results.

• Encourages collaboration with team members based on trust, mutual respect, consistent visible support, and open and honest communication.

Supervisory Responsibilities

• The incumbent will be responsible for the general direction of staff member(s).

Blood Borne Pathogen Exposure

• Category III: Job does not involve exposure to blood, body fluids, non-intact skin or tissue specimens. Incumbent does not perform or help in emergency medical care or first aid as a part of his/her job.

Protected Health Information Access Level

• Level IV - Full Access Incumbents in this job may access any protected health information associated to a customer's needs, the service(s) rendered and the position's functions.

Working Environment

• This job operates in an office environment.

Physical Requirements

• Sedentary Work: Lifting 10 lbs. maximum and occasionally lifting and/or carrying such articles as dockets, ledgers and small tools. Although a sedentary job is defined as one that involves sitting, a certain amount of walking and standing is often necessary in carrying out job duties. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Travel Requirements

• Requires frequent local travel. Must have a vehicle or access to a motor vehicle.

DC RESIDENTS ENCOURAGED TO APPLY