Leads and supervises multidisciplinary team of healthcare services professionals in some or all of the following functions: care management, utilization management, behavioral health, care transitions, long-term services and supports (LTSS), and/or other special programs. Ensures members reach desired outcomes through integrated delivery and coordination of care across the continuum, and contributes to overarching strategy to provide quality and cost-effective member care.
Assists in implementing health management, care management, utilization management, behavioral health and other program activities in accordance with regulatory, contract standards and accreditation compliance.
Functions as a "hands-on" supervisor, assisting with assessing and evaluation of systems, day-to-day operations and efficiency of operations/services.
Assists in the coordination of orienting and training staff to ensure maximum efficiency and productivity, program implementation, and service excellence.
Trains and supports team members to ensure high-risk, complex members are adequately supported.
Assists with staff performance appraisals, ongoing monitoring of performance, and application of protocols and guidelines.
Collaborates with and keeps healthcare services leadership apprised of operational issues, staffing, resources, system and program needs.
Assists with coordination and reporting of department statistics and ongoing client reports, as assigned.
Local travel may be required (based upon state/contractual requirements).
At least 5 years health care experience, and at least 2 years of managed care experienced in one or more of the following areas: utilization management, care management, care transitions, behavioral health, long-term services and supports (LTSS), or equivalent combination of relevant education and experience.
Registered Nurse (RN), Licensed Vocational Nurse (LVN), Licensed Practical Nurse (LPN), Licensed Clinical Social Worker (LCSW), Licensed Marriage and Family Therapist (LMFT), Licensed Professional Clinical Counselor (LPCC), or Licensed Master of Social Work (LMSW). Clinical licensure and/or certification required ONLY if required by state contract, regulation, business operating model, or state board licensing mandates. If licensed, license must be active and unrestricted in state of practice.
Ability to manage conflict and lead through change.
Operational and process improvement experience.
Strong written and verbal communication skills.
Working knowledge of Microsoft Office suite.
Ability to prioritize and manage multiple deadlines.
Excellent organizational, problem-solving and critical-thinking skills.
Registered Nurse (RN). License must be active and unrestricted in state of practice.
Certified Case Manager (CCM), Certified Professional in Health Care Management certification (CPHM), Certified Professional in Health Care Quality (CPHQ) or other health care or management certification.
Medicaid/Medicare population experience.
Clinical experience.
Supervisory/leadership experience.
Supervisor, Healthcare Services (Utilization Management) • Saint Petersburg, FL, United States
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