Job Description

Manager of Case Management/Transition of Care (TOC) is responsible for the day to day operations within the Case Management and Transition of Care Department. This position is responsible for the development of Case Management processes (CM/DM). The Senior Manager of Case Management/Transition of Care reports directly to the Senior Director of Integrated Care Coordination and interfaces with provider's, families and physicians as well as health plan staff including Medical Director(s), and other Health Choice personnel as needed.

Job responsibility:

Oversee the day-to-day clinical and financial operations of the Case Management and TOC department, leading the growth and development of programs and services that ensure the needs of members are met across the continuum of care:

* Supports the Medical Management/Utilization Management Committee in its activities and ensures staff is skilled in applying standard clinical guidelines

* Responsible for departmental planning and goal setting; clinical supervision and personnel management; implement quality improvement initiatives; interdisciplinary care teams, ensure community and provider relations; facilitate financial management, policy and procedure development and provide professional staff orientation and development. 

* In collaboration with the Senior Director review and revise the Case Management and TOC program descriptions annually or as indicated by contract or accreditation requirements and conducts annual evaluation of Care Management programs and TOC processes per contract or regulatory requirements.

* Responsible for all quarterly deliverables to AHCCCS for the departments

* Participate in all regulatory audits by AHCCCS and CMS

* Program changes are made when outcomes do not meet minimum performance standards

* Data from differing sources  are compared and discrepancies analyzed

Develop and maintain collaborative partnerships with the Health Choice leadership team and promote inter-departmental collaboration to drive initiatives:

* Identifies, assesses, develops and implements cross-functional, cross-departmental work processes that impact various departments or the company to improve clinical outcomes including opportunities to improve clinical care, customer service, and internal business processes.

* Responsible for assessment, planning, implementation, tracking, monitoring, coordination, reconciliation and evaluation of the managed care member’s performance across the continuum of care to include the complete transition of care to outpatient care.

* In collaboration with the Senior Director, develops staff performance objectives based on identified improvement or developmental opportunities and aligns with organizational performance outcome objectives.

* Works closely with other managers and co-workers in order to ensure project deliverables are met in a timely and efficient manner.

* In collaboration with the Senior Director, creates, implements and monitors policies and procedures for contract and accreditation compliance.

* Provides high level consultation to senior leaders for performance revisions, integrations and conversions, healthcare strategies, product development, policy and procedure changes and/or cost control opportunities.

Focus on Quality Improvement Initiatives including performance measures

* Develop and implement processes to ensure accurate data collection

* Analyze available data to make programmatic changes to improve outcomes

* Create, maintain, and submit reports required by regulatory agencies and the health plan

* Identify new strategies to meet or exceed performance measures

Expected Outcome(s):

* Achieve cost management PMPM and low net cost goals as determined by Health Choice Finance

* Successful achievement of health plan performance goals and timely deliverables

* Maintain compliance with all applicable regulations and guidelines 

* Improve performance measures specific to the departments

* Ensure compliance across all department processes

* Departments are adequately equipped to achieve and/or exceed department and organizational goals.

* Successful accomplishment of process improvement projects and goals results in compliance with regulatory standards, as well as increased effectiveness and efficiency across departments.

* Reports are completed and submitted on time

Health Choice exists to improve the health and well-being of the individuals we serve through our health plans, integrated delivery systems and managed care solutions. We strive to recruit and retain only the finest health care professionals with the highest levels of integrity, compassion and competency. If you are driven by your own personal commitment to these values and desire to work in a team-focused, collaborative and supportive environment - while still being valued for your individual strengths - Health Choice is the place for you.

Equal Opportunity Employer Minorities/Women/Veterans/Disabled



Bachelor's degree in Nursing from an accredited school of nursing

Active Arizona Registered Nurse (RN) license, in good standing

At least three (3) years of management experience

At least three (3) years of managed care experience with clinical program development

At least three (3) years of experience in case management

Ability to strategize and implement a strategic plan and analyze and interpret statistical health plan data

Ability to supervise and lead others

Ability to manage a large workload

Ability to maintain a positive work environment for employees

Ability to maintain positive work relationships

Handle multiple and changing priorities at a fast pace

Working knowledge of Access database and Excel

Work cooperatively, positively, and collaboratively in an interdisciplinary team

Application Instructions

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