Supervisor, Enhanced Care Management (Non-Clinical)

Job Summary

The Supervisor, Enhanced Care Management (Non-Clinical) ensures that the quality levels of performance and authorization timeliness are maintained throughout the Enhanced Care Management (ECM) Department, The position is responsible in ensuring that all functions remain in compliance with State and Federal regulations. This position will manage new program implementations and/or system implementations. This position must maintain an up-to date knowledge of national and statewide standards and regulations pertaining to authorizations processes.  The Supervisor will ensure that production standards meet quality guidelines throughout the department ensuring the Plan’s compliance. This position will work with senior management and staff to develop procedures ensuring the achievement of goals and will continuously monitor the work performed within the Department. This position will be responsible for analyzing, trending, and ensuring assignment of all ECM member cases. Responsible for the development and maintenance of the ECM procedures, workflows, member correspondence, and training as needed, or on an annual basis.

The position supervises all aspects of running an efficient team, including hiring, supervising, coaching, training, disciplining, and motivating direct reports.

Duties

Evaluates daily reports to ensure individual and team Key Performance Indicators (KPIs), Service lLevel Agreements (SLAs), Performance Scorecards meet regulatory requirements.  Track and trend the metrics associated with the authorization timelines. Prepare and present written and verbal reports. Research complex problem areas within the department or within the systems used by department, and identify the root cause of these issues and recommend corrective actions.

Supervise staff , including, but not limited to: monitoring of day to day activities of staff, monitoring of staff performance, mentoring, training, and cross-training of staff, handling of questions or issues, etc. raised by staff, encourage staff to provide recommendations for relevant process and systems enhancements, among others.

Responsible for the daily workflow and leading the work of assigned staff.  This role will mentor, coach, act as a resource and provide feedback on performance of assigned staff.

Builds and maintains strong working relationships with internal departments and external stakeholders involved in the coordination of care for ECM members.

Create, maintain and monitor departmental documents including policies, procedures, desktop procedures, workflow documents and job aids to ensure these documents are current and meet the requirements of L.A. Care.

Audit preparation and providing recommendations for Corrective Action Plans from state regulatory agencies.

Performs other duties as assigned.

Duties Continued

Education Required

Education Preferred

Experience

Required:

Minimum 1 year of  administrative experience in a healthcare or managed care setting, case management, authorization processes and/or claims with a minimum of 6 months  of leading a process, program or staff or supervisory experience.

Equivalency: 

Completion of the L.A. Care Management Certificate Training Program may substitute for the supervisory/management experience requirement.

Preferred:

Previous experience in Managed Care preferably in Customer Service, Care Management, Appeals and Grievances and/or Claims.

Participated in a 2-year management-mentoring program.

Skills

Required:

Ability to manage and organize large volumes of data.

Knowledge of regulatory and accreditation entities and their requirements.

Excellent verbal and written communication skills and interpersonal skills.

Good working knowledge of licensure and regulatory requirements, and accreditation standards.

Ability to work independently.

Position requires the ability to multi task in a high production environment.

Ability to solve complex issues and identify creative solutions.

Microsoft Office (Word, Excel, Power Point, Access, and Visio).

Preferred:

Knowledge of L.A. Care core computer system.

Bilingual in one of LA Care Health Plan’s threshold languages is highly desirable. English, Spanish, Chinese, Armenian, Arabic, Farsi, Khmer, Korean, Russian, Tagalog, Vietnamese  

Licenses/Certifications Required

Licenses/Certifications Preferred

Required Training

Physical Requirements

Additional Information