Not Authorized
You are currently not authorized to access this section.
Please contact your Administrator to change your authorization settings.
Please contact your Administrator to change your authorization settings.
(RN) Community Well Care Coordination Manager
Indianapolis, IN
Job Description
The Community Well Care Coordination Manager must oversee the care coordination, complex case management functions for PathWays to Aging members who live in the community and who are not receiving Home and Community Based Services (HCBS) or designated as Nursing Facility Level of Care (NFLOC). The Care Coordination Manager must, at a minimum, be a registered nurse or similar medical professional with extensive experience in providing care coordination to members 60 years and older. This individual will work directly under the Health Services Directors to maintain the care coordination program. The individual will be responsible for overseeing care coordination teams, care plan development and care plan implementation. The Care Coordination Manager will be responsible for directing the activities of the care coordinators. These responsibilities extend to physical and behavioral health care services. This individual will work with the Heath Services Director, Service Coordinator Administrator, Medical Director, Provider and Member Services Managers, and with State staff as necessary, to communicate to providers and members. The Care Coordination Manager will provide input, as requested by the State, at State-level meetings.
Primary Responsibilities:
* Selects, manages, develops, mentors and supports staff in designated department or region
* Develops clear goals and objectives for performance management and effectively communicates expectations, and holds the team accountable for results
* In order to meet the unique needs of our members, have an intimate understanding of the contractual requirements
* Identify, select, structure, and prioritize process improvement projects, ultimately implementing changes to meet program requirements
* Ensures standardized execution of workflow processes, including conducting performance audits, quality reviews, and compliance adherence
* Assess, plan and implement care strategies that are individualized by patient and directed toward the most appropriate, least restrictive level of care
* Identify and initiate referrals for social service programs; including financial, psychosocial, community and state supportive services
* Communicate with all stakeholders the required health-related information to ensure quality coordinated care and services are provided expeditiously to all members
* Advocate for patients and families as needed to ensure the patient's needs and choices are fully represented and supported by the health care team
* Participates in training and coaching of direct reports as needed
* Conducts bi-annual field visits with direct reports to observe, provide areas of teaching, address issues and concerns and foster a good working relationship
* Collaborates across Optum and UHG and interacted with Medical Directors, Site Directors, Senior Leaders, Network, Marketing, Account Management, Quality, Product, and other stakeholders
Required Qualifications:
* Resident of Indiana
* BSN or BSW with equivalent experience
* Registered Nurse with an unrestricted License in Indiana
* Experience working within the community health setting in a health care role
* Experience or knowledge of Indiana Medicaid, Medicare, Long term care
* Experience coaching or mentoring staff
* Intermediate level of experience with Microsoft Word, with the ability to navigate a Windows environment
Preferred Qualifications:
* 3+ year of case management leadership experience within a healthcare industry
* Background in managed care
* Case Management experience
* Certified Case Manager (CCM)
* Experience / exposure with members receiving long term social supports
* Experience in utilization review, concurrent review and/or risk management
PME is an equal opportunity employer. We prohibit discrimination and harassment against any applicant or employee based on any legally recognized basis, including, but not limited to: veteran status, uniformed servicemember status, race, color, religion, sex, sexual orientation, gender identity, age (40 and over), pregnancy, national origin or ancestry, citizenship status, physical or mental disability, genetic information (including testing and characteristics) or any other category protected by federal, state or local law.
It is the policy of the Company to provide equal employment opportunities to all qualified individuals and to administer all aspects and conditions of employment without regard to the following:
• Race and associated traits, including hairstyle; Color, Age, Sex, Sexual orientation, Gender, Gender identity and gender expression; Religion, including dress and grooming practices; National origin, including language use restrictions; Pregnancy, childbirth, or breastfeeding; Marital or familial status; Genetic information, including family medical history; Physical or mental disability; Citizenship and/or immigration status
• Medical conditions, including cancer, AIDS/HIV, and occupational pneumoconiosis without respiratory impairment
• Denial of family or medical care leave
• Use of a guide or support animal
• Military or veteran status
• Political activities or affiliations
• Exercise of civil rights
• Domestic violence, assault, or stalking victim status
• GED certificate
• Arrest, expunged, or sealed records
• Application for or enrollment in Medi-Cal
• Status as a smoker or non-smoker
• Credit report or credit information
• Child or spousal support withholding
• Wage garnishment for consumer debt
• Relationship with someone with a disability
• Lawful conduct occurring during nonworking hours not on Company premises
• Any other protected class, in accordance with applicable federal, state, and local laws
Discriminatory, harassing, or retaliatory behavior is prohibited from coworkers, supervisors, managers, owners, and third parties, including clientele. The Company takes allegations of discrimination, harassment and retaliation very seriously and will promptly conduct an investigation when warranted. Equal employment opportunity includes, but is not limited to, employment, training, promotion, demotion, transfer, leaves of absence and termination.
Primary Responsibilities:
* Selects, manages, develops, mentors and supports staff in designated department or region
* Develops clear goals and objectives for performance management and effectively communicates expectations, and holds the team accountable for results
* In order to meet the unique needs of our members, have an intimate understanding of the contractual requirements
* Identify, select, structure, and prioritize process improvement projects, ultimately implementing changes to meet program requirements
* Ensures standardized execution of workflow processes, including conducting performance audits, quality reviews, and compliance adherence
* Assess, plan and implement care strategies that are individualized by patient and directed toward the most appropriate, least restrictive level of care
* Identify and initiate referrals for social service programs; including financial, psychosocial, community and state supportive services
* Communicate with all stakeholders the required health-related information to ensure quality coordinated care and services are provided expeditiously to all members
* Advocate for patients and families as needed to ensure the patient's needs and choices are fully represented and supported by the health care team
* Participates in training and coaching of direct reports as needed
* Conducts bi-annual field visits with direct reports to observe, provide areas of teaching, address issues and concerns and foster a good working relationship
* Collaborates across Optum and UHG and interacted with Medical Directors, Site Directors, Senior Leaders, Network, Marketing, Account Management, Quality, Product, and other stakeholders
Required Qualifications:
* Resident of Indiana
* BSN or BSW with equivalent experience
* Registered Nurse with an unrestricted License in Indiana
* Experience working within the community health setting in a health care role
* Experience or knowledge of Indiana Medicaid, Medicare, Long term care
* Experience coaching or mentoring staff
* Intermediate level of experience with Microsoft Word, with the ability to navigate a Windows environment
Preferred Qualifications:
* 3+ year of case management leadership experience within a healthcare industry
* Background in managed care
* Case Management experience
* Certified Case Manager (CCM)
* Experience / exposure with members receiving long term social supports
* Experience in utilization review, concurrent review and/or risk management
PME is an equal opportunity employer. We prohibit discrimination and harassment against any applicant or employee based on any legally recognized basis, including, but not limited to: veteran status, uniformed servicemember status, race, color, religion, sex, sexual orientation, gender identity, age (40 and over), pregnancy, national origin or ancestry, citizenship status, physical or mental disability, genetic information (including testing and characteristics) or any other category protected by federal, state or local law.
It is the policy of the Company to provide equal employment opportunities to all qualified individuals and to administer all aspects and conditions of employment without regard to the following:
• Race and associated traits, including hairstyle; Color, Age, Sex, Sexual orientation, Gender, Gender identity and gender expression; Religion, including dress and grooming practices; National origin, including language use restrictions; Pregnancy, childbirth, or breastfeeding; Marital or familial status; Genetic information, including family medical history; Physical or mental disability; Citizenship and/or immigration status
• Medical conditions, including cancer, AIDS/HIV, and occupational pneumoconiosis without respiratory impairment
• Denial of family or medical care leave
• Use of a guide or support animal
• Military or veteran status
• Political activities or affiliations
• Exercise of civil rights
• Domestic violence, assault, or stalking victim status
• GED certificate
• Arrest, expunged, or sealed records
• Application for or enrollment in Medi-Cal
• Status as a smoker or non-smoker
• Credit report or credit information
• Child or spousal support withholding
• Wage garnishment for consumer debt
• Relationship with someone with a disability
• Lawful conduct occurring during nonworking hours not on Company premises
• Any other protected class, in accordance with applicable federal, state, and local laws
Discriminatory, harassing, or retaliatory behavior is prohibited from coworkers, supervisors, managers, owners, and third parties, including clientele. The Company takes allegations of discrimination, harassment and retaliation very seriously and will promptly conduct an investigation when warranted. Equal employment opportunity includes, but is not limited to, employment, training, promotion, demotion, transfer, leaves of absence and termination.
Job Summary
Start Date
As soon as possible
Employment Term and Type
Regular, Full Time
Required Experience
3+ years
Email this Job to Yourself or a Friend