Manager - Community Care Management (Hybrid, North Carolina Based)

The Manager of Care Management provides support, supervision and development of Care Manager II Supervisors within the Care Management Department at all Alliance locations.

This position will allow the successful candidate the ability to work remote certain days of the week. The employee will also be required to come into the office closest to their home office location on certain days as approved by their supervisor. This position will require travel within the communities Alliance serves as needed.

Responsibilities and Duties

Staff Management and Development

• Work with Human Resources and Director of Community Care Management to maintain and retain a highly qualified and well-trained workforce
• Ensure staff are well trained in and comply with all organization and department policies, procedures, and business processes
• Organize workflows and ensure staff understand their roles and responsibilities
• Ensure the department has the needed tools and resources to achieve organizational goals and to support employees and ensure compliance with licensure, regulatory, and accreditation requirements
• Actively establish and promote a positive, diverse, and inclusive working environment that builds trust
• Ensure all staff are treated with respect and dignity
• Ensure standards are transparent and applied consistently, impartially, and ethically over time and across all staff members
• Work to resolve conflicts and disputes, ensuring that all participants are given a voice
• Set goals for performance and deadlines in line with organization goals and vision
• Effectively communicate feedback and provide ongoing coaching and mentoring to staff and support a learning environment to advance team skills and professional development
• Cultivate and encourage efforts to expand cross-team collaboration and partnership

Collaborate with External, and Internal Stakeholders

• Develop strong working relationships with providers and external stakeholders by scheduling ongoing opportunities to share feedback and collaborate
• Participate in local, regional, and state meetings as required
• Exercise conflict resolution skills to appropriately resolve issues with providers and external stakeholders
• Develop strong working relationships within Provider Networks, Provider Network Evaluation, as well as other departments by scheduling ongoing opportunities to share feedback, collaborate, and identify shared responsibilities for achieving program and organizational deliverables

Implement Recommendations for Continuous Quality Improvement

• Review, validate and interpret risk stratification data and population health groups and recommend changes or adjustments to care management approach as needed
• Utilize data systems to monitor process improvement and resource utilization
• Knowledgeable of HEDIS measurements and population health within a complete care model
• Utilize evidence-based practice to ensure quality outcomes for members
• Implement recommendations to improve department procedures and increase operational efficiency
• Monitor trends and identify opportunities for enhancements in service utilization and implementation throughout Alliance

Oversee Program Operations and Development

• Develop and support program operations in new Alliance regions, while adhering to Tailored Plan standards
• Participate in the initiation, development, and maintenance of clinical protocols and other population-based programs, facilitating collaboration and consensus of multidisciplinary teams as complete care is developed
• Oversee the development of department specific goals and objectives ensuring alignment with system strategy, vision, mission, and values
• Formulate, implement, and evaluate strategies for specialized staff education as it relates to member care, case management and plans of care

Oversee Documentation Maintance and Reporting

• Maintain medical record compliance/quality
• Ensure timely documentation of Care Coordination activities as required by department policy and procedures
• Monitor completion of documentation in all systems to ensure data is entered timely and accurately
• Oversee the collection and delivery of data requests impacting program operations

Comply with Policies, Procedure, Processes, and Workflows

• Adhere to all Alliance Organizational Policies and Procedures and Care Management Desk Procedures

Minimum Requirements

Graduation from an accredited school of nursing with Licensure as a registered nurse and five (5) years of experience with at least two (2) years of applicable experience with the population serv