Job Description

The primary responsibility of this role is to oversee the day-to-day operations of a team of nurses who assist their onshore counterparts with administrative case management tasks. To monitor performance according to established standards and conducts performance evaluations. They will be responsible to plan, direct, supervise and evaluate workflow as well as to coordinate work activities to achieve volume expected and meet operational requirements.

Clinical Management

• Oversees the implementation of Highmark Clinical Case Management Support including but not limited to Case Management (CM) screening/Telephonic Outreach/Program Enrollment/Task Support for Case Management and monitors daily performance to ensure business goals are met and compliance with Highmark policies and procedures is maintained
• Implements clinical policies & procedures in accordance with NCQA, URAC, state and federal standards and mandates
• Serve as a content model expert and mentor to the team regarding practice standards, quality of interventions, problem resolution and critical thinking
• Ensure implementation and monitoring of best practice approaches and innovations to better address the member's needs across the continuum of care
• Protects the confidentiality of member information and adheres to company policies regarding confidentiality
• Manages resources responsible for identification of members, development and implementation of care plans, enhancement of medical appropriateness and quality of care and monitoring
• Communicates productivity expectations, balance workload (e.g., daily team meetings to discuss new referrals), monitor efficiency and initiate control measures to minimize variances in workload over time
• Ensures the team's understanding and use of information system capability and functionality
• May have responsibility for their own case load work

Team Management

• Select staff using clearly defined requirements in terms of education, experience, technical and performance skills
• Assesses developmental needs and collaborates with others to identify and implement action plans that support the development of high performing teams
• Establish an environment and work style that promotes the concept of teamwork, cross product integration, and continuum of care thinking that results in strong performance
• Articulate performance expectations and team objectives while collecting and interpreting balanced measure to evaluate individual staff and team performance
• Lead change efforts while managing transitions within a team
• Create a positive work environment by acknowledging team contributions, soliciting input, and offering personal assistance when needed
• Accountable for maintaining compliance with Human Resource policies and procedures and implements them at the employee level
• Sedentary work involving periods of sitting, talking, hearing, work requires visual acuity to perform close inspection of handwritten and computer-generated documents as well as a PC monitor
• Typical office working environment

Active PHRN with minimum 1 year bedside experience.
Communication Skills Requirement (B2-C1 in HLEAP)