POSITION SUMMARY

The Supervisor, Case Management (CM) supports the Senior Manager (Sr. M) and Assistant Manager, Medical Management (MM) in daily operations related to MM systems, integration, configuration, testing, functionality, quality, staff education, CM related reports and day-to-day staff operations. The Supervisor, CM is the primary contact for CM related escalations and represents CM in cross-functional internal collaborations.The Supervisor, CM adheres to Community Health Options MM approach that balances advocacy for the individual with stewardship for the entire membership through effective utilization management strategies. Incumbent remains nimble and consistently demonstrates ability to swiftly adapt and flex work assignments to meet daily operational priorities.

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES

• The Supervisor, CM supports the Sr. M and Assistant Manager in ensuring CM documentation platform configuration, integration, correspondence, reporting, and user access complies with all State & Federal regulation and National Committee for Quality Assurance (NCQA) standards.
• Closely collaborates with subject matters experts (SMEs) to inform system configuration and workflow preferences.
• Provides system education and supporting documents to facilitate efficient and effective use of MM systems.
• Supports Sr. Manager and Assistant Manager, MM as CM SME in the development and implementation of CM functionalities (notes, assessments, turn-around-times, workflows).
• Performs periodic audits and quality assurance testing and system reviews as necessary and/or upon request of the leadership team.
• Monitors individual team member performance and provides mentoring and coaching as needed to promote consistent adherence to standards and shared ownership of quality outcomes.
• Maintains confidentiality in all aspects of Member, Health Options’ people and company information.
• Any other project work or supportive duties as assigned.

JOB SPECIFIC KEY COMPETENCIES (KSAs)

• Appreciation of cultural diversity and sensitivity towards individual preferences.
• Ability to adapt and be nimble to effectively problem-solve complex, multifaceted, and/or emotionally charged situations.
• Proficient in English with verbal, written, interpersonal and public communications.
• Ability to function independently and proactively while actively pursuing knowledge and resources to manage daily work effectively and efficiently.
• Advanced skills in Microsoft Products and adaptability to varied electronic documentation systems.
• Must have excellent attention to detail with ability to act autonomously to maintain production levels and quality standards with minimal direct supervision.
• Ability to quickly prioritize and handle multiple projects at one time under tight deadlines.
• Excellent communication, writing, analytical and problem-solving skills.

DIVERSITY, EQUITY, AND INCLUSION STATEMENT

Community Health Options is committed to fostering, cultivating, and preserving a culture of diversity, equity, and inclusion (DEI). Our human capital is the single most valuable asset we have. The collective sum of individual differences, life experiences, knowledge, inventiveness, innovation, self-expression, unique capabilities, and talent our employees invest in their work represents a significant part of not only our culture, but our reputation and achievement as well. Community Health Options DEI initiatives are applicable, but not limited to, our practices and policies on recruitment and selection; compensation and benefits; professional development, and training; promotions; transfers; social and recreational programs, and the ongoing development of a work environment built upon the premise of DEI, which encourages and enforces:

• Respectful, open communication and cooperation between all employees.
• Teamwork and participation, encouraging the representation of all groups and employee perspectives.
• Balanced approach to work culture through flexible schedules to accommodate varying needs of our people.
• Employer and employee contributions to the communities we serve to promote a greater understanding and respect for each other.

QUALIFICATIONS AND CORE REQUIREMENTS

• Bachelor's degree in health-related field, preferred.
• 3-5 years of case management work experience required.
• Active CCM designation required.
• Active and unrestricted Compact or Maine RN licensure.
• Previous leadership experience required.

REMOTE WORKERS:

• Must provide sufficient internet bandwidth to meet system operational needs and have a home office environment that protects the privacy and integrity of confidential information.

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