JOB SUMMARY
The Manager will supervise all Care Management (CM) functions for CHC and CHC members in the CM programs. The Manager will supervise CM staff in the enrollment and ongoing outreach to CHC members and care-coordination to members in the CM programs. The Manager will review all programs at least annually and work with Medical Affairs staff and senior leadership to update program goals and content. In addition, the Manager will identify other conditions for which CHC should prepare a care management program. The Manager will work with Analytics and Medical Affairs staff/management team to ensure that 1) members are being contacted and enrolled appropriately; program results, including ROI when measurable, are reported on a quarterly basis; program problems are identified; and 4) process improvements are recommended and implemented.

JOB SPECIFICATIONS AND CORE COMPETENCIES
Oversees daily management of Care Management staff, including timecards,
counseling, coverage, etc. Ensures that the regulatory turnaround times and deadlines are met.

Ensures that monthly reports are reviewed with Director of Quality & Outcomes and Medical Affairs management team as needed monthly and implements appropriate corrective actions. Updates CM sections of the Key Management Report (KMR).

Develop action plans to measure results and possible ROI for every program.
Develop new and update existing policies, procedures and job aids that relate to Care Management programs as needed to ensure compliance with HHSC, TDI,
UMCC, NCQA and URAC standards.

Ensures that all CHC members identified as candidates for CM programs are processed and evaluated within the specified time frames. Monitor events and outcomes of members enrolled in Care Management.

Actively contributes to achievement of departmental goals, as identified in Departments annual business plan, including specific departmental process improvement plans. Other duties as assigned.


QUALIFICATIONS:
Education/Specialized Training/Licensure: Active Texas RN license required.

BSN preferred. Certification in Clinical Case Management (CCM) preferred.

Work Experience (Years and Area): 5 years' experience in Care Management (Disease Management) or Care Management in an acute care setting or MCO. Other healthcare experience will be considered in lieu of CM experience.

Management Experience (Years and Area): 3 years experience in management / leadership role.

Software Proficiencies: Microsoft Office (Word, Excel, Access, Outlook)