Manager Case & Disease Management

Job Summary

Provides supervision and leadership to the team of Priority Health Case Managers and support staff. Responsible for the operations and acts as a resource and consultant to the team to ensure that the goals and standards of the department and Priority Health programs are being met. Provides oversight of processes and procedures to assure that the individual's specific health needs are met to promote the highest quality of care in the most appropriate setting.

DIRECTION EXERCISED:
Directly supervises regional employees. Responsibilities include but are not limited to effective interviewing, hiring and training employees; planning, assigning and directing work, appraising performance; rewarding and counseling employees; addressing complaints and resolution.

Essential Functions

• Departmental
  • Assures the integration of Priority Health Case and Disease Management operations inter- and intra-departmentally.
  • Develops and implements training modules for Case and Disease Management operations.
  • Develops and supports marketing materials for Case Management in conjunction with Sales and Marketing.
  • Program development: In conjunction with the Director, Care Management, determines the case and/or disease management needs for the new products/services.
  • Researches, analyzes and defines programs; develops the structure and key elements of the program.
  • Manages the development of the new programs from concept to implementation.
  • Provides post-implementation monitoring and oversight as assigned.
  • Serves as a contact/resource for internal and external customers re: Priority Health Case and Disease Management, including assisting with/participation in internal and external presentations, in conjunction with the Director, Care Management.
  • Ensures representation in internal and external committees that promote the goals and value position of the Priority Health Case Management team.
  • Participates in the development of measureable outcomes, ensures measures are in place to monitor the impact of programs and services on the health status of the member managed.
  • Demonstrates and utilizes knowledge of appropriate resources within the company, health care system and community.
• Leadership
  • Responsible for supervising, planning, administering and controlling activities of the Priority Health Case and Disease Management team.
  • Monitors the day-to-day operations of the Priority Health Case and Disease Management team to identify barriers to providing excellent service to Priority Health members.
  • Responsible for hiring, developing and evaluation of the staff of the Case and Disease Management team.
  • Provides leadership to the individuals responsible for the program operations including coaching and mentoring to direct reports.
  • Motivates departmental personnel assigned to the program to ensure program effectiveness.
  • Identifies opportunities for improvement and takes action.
  • Provides input into the development, implementation and evaluation of departmental goals and objectives.
  • Plans and implements orientation and training of new-hire employees.
  • Establishes priorities and goals for direct reports.
  • Delegates work to direct reports appropriately and effectively.
  • Systematically evaluates the quality and effectiveness of staff performance, analyzing appropriate data and information to identify areas of improvement; advises and coaches when appropriate and completes annual performance appraisals.
  • Performs (or oversees) quality review and audit of staff.
  • Participates in the review, revision and approval of policies and procedures. Accountable for compliance to policies and procedures pertaining to case management activities.
  • Effectively delegates activities associated with area of responsibility.
  • Participates in the development and implementation of best practices that further the Priority Health value position.
  • Ensures timely and accurate distribution of communications.
• Corporate
  • Participates in interdepartmental committees and/or workgroups that are pertinent to areas of responsibility.
  • Maintains knowledge and understanding of all regulatory and accrediting requirements pertinent to Priority Health Case and Disease Management.
  • Effectively intercedes with other employees/departments to resolve concerns related to staff or process.
  • Collaborates with the Director, Care Management to develop and implement Health Management Programs consistent with Priority Health’s overall strategy.
  • Focuses on results by seeking to constantly improve them. Collaborates with other managers in the Health Management department to ensure appropriate performance monitoring are occurring and action plans are developed as needed.
  • Assists Provider Services,