Care Management Team Lead
$72,870–$137,290 year
HybridHarrisburg, Pennsylvania, United States
Job Summary
Oversee daily operations of the Care Management unit, including Case Management, Disease Management, Social Work, and specialty programs. Evaluate care management process implementation, productivity metrics, and regulatory compliance while directly supervising staff and driving performance improvement. Facilitate ongoing staff development through mentorship, regular feedback, and quarterly audits of phone calls and documentation. Lead case reviews to enable co-management and multidisciplinary communication, while troubleshooting complex member needs and provider issues. Report quality of care issues in accordance with departmental policies and collaborate with leadership to resolve identified challenges. Primarily remote with variable hours and occasional travel. Requires RN or MSW degree, five years of care management experience, and knowledge of NCQA and CMSA standards.
Required Qualifications
- At least five (5) years' experience as a care manager: Case Manager, Disease Manager, Social Worker or equivalent experience
- Supervisory/leadership experience
- Registered Nurse with a bachelor's degree (or higher) in a health-related field
- Master's in Social Work degree
- Active licensure in home state
- Additional state licensure as needed to meet customer needs
- Possession of a valid driver's license
- Ability to travel to provider, facility, employer group and/or member locations using own vehicle, if appropriate
- Case Management Certification
- National certification as a case manager
- Knowledge of NCQA standards for Population Health Management for health plan accreditation
- Knowledge of DMAA standards for disease management
- Knowledge of CMSA Standards of Practice for Case Management
- Knowledge of Act 68
- Knowledge of NCQA
- Knowledge of CMS
- Knowledge of ERISA
- Knowledge of clinical and managed care principles and operations
- Knowledge of current and emerging medical treatment modalities and best practice guidelines with the ability to analyze and interpret medical and benefit coverage interrelationships
- Knowledge of adult learning principles
- Knowledge of motivational interviewing
- Knowledge of intrinsic coaching techniques
Desired Qualifications
- Supervisory/leadership experience preferred
- Case Management Certification preferred
- Subsequent to completing one (1) year in the position, the incumbent must obtain national certification as a case manager
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