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Manager, Field Care Management RN (field case management) at WellCare

Posted in Health Care 30+ days ago.

This job brought to you by eQuest

Type: Full-Time
Location: Chicago, Illinois

Job Description:

Manages the day-to-day activities of the Field Service Coordinators and Supervisors. Ensures the case management process of assessing, planning, implementation, coordination, monitoring, and evaluating services and outcomes is pursued to maximize the health of the Member. Promotes effective healthcare utilization, monitors health care resources and assumes a leadership role within the Interdisciplinary Care Team (ICT) to achieve optimal clinical and resource outcomes for member. Oversees the socio economic needs and services of selected member populations across the continuum of illness. Provides ongoing support and oversight to staff.


DEPARTMENT:  Health Services

REPORTS TO:  Vice President, Field Health Services

Essential Functions:

  • Provides ongoing consultation to Field Service Coordinators and reviews caseloads on an ongoing basis, both through regular face-to-face supervision sessions and review of management reports and deadlines.

  • Assists Medical Director and Dir, Field Service Coordination in creating department goals, objectives and metrics.

  • Oversees the implementation of programs and strategies.

  • Develops and implements case management workflows and policies & procedures.

  • Proactively monitors appropriate metrics to drive up efficiency.

  • Perform audits of assessments, care plans and service notes to verify cases are properly established and that member coordination activities are occurring and appropriately documented.

  • Coordinates activities of unit to meet contractual company deadlines and resolves interpersonal conflicts.

  • Partners & collaborates with other departments cross functionally regarding care and case management and/or Health Service initiatives.

  • Directs work assignments, measures results and initiates personnel actions as required.

  • Develops, implements and manages process improvement initiatives.

  • Monitors associate performance and conducts counseling/corrective action procedures when required. Identifies concerns, brings issues to management’s attention and offers suggestions for improvement.

  • Reviews time records, sets schedules and approves all vacation/time off requests for subordinate associates.

  • Provides training and guidance to new and current Field Service Coordinators regarding policy & procedure, systemic tools, workload and care/case plan development.

  • Answers all questions and assists peers and management with delegated tasks or projects.

  • Ensures compliance with all state and federal regulations as well as Corporate guidelines in day-to-day activities.

  • Performs special projects as needed.

Additional Responsibilities:

  • Will manage some remote team members, and will need to be able to travel within the state as needed.


Candidate Education:

  • Required an Associate's Degree in Nursing

  • Preferred a Bachelor's Degree in Nursing or Health Administration

Candidate Experience:

  • Required 5+ years of experience in case management, clinical acute care, home health, hospice, physician's office or public health

  • Required 3+ years of experience in managed care

  • Required 1+ year of management experience

  • Preferred NCQA, EQRO accreditation experience

  • Preferred specialty experience - In consideration of a specialty program or as a specific discipline leader i.e. Obstetrics, must have at least 5 years of experience or hold a national certification in that area of specialty (in states where applicable)

Candidate Skills:

  • Intermediate ability to communicate and make recommendations to upper management

  • Intermediate demonstrated time management and priority setting skills

  • Intermediate ability to lead/manage others

  • Intermediate ability to create, review and interpret treatment plans

  • Intermediate demonstrated negotiation skills

  • Intermediate demonstrated problem solving skills

  • Intermediate demonstrated interpersonal/verbal communication skills

  • Intermediate knowledge of community, state and federal laws and resources

  • Intermediate ability to effectively present information and respond to questions from families, members, and providers

  • Intermediate demonstrated written communication skills

  • Intermediate knowledge of healthcare delivery

  • Intermediate ability to multi-task

  • Intermediate demonstrated written communication skills

  • Intermediate ability to lead and manage others in a metric driven environment

  • Intermediate ability to implement process improvements

  • Intermediate knowledge of medical terminology and/or experience with CPT and ICD 10 coding

Licenses and Certifications:
A license in one of the following is required:

  • Required Licensed Registered Nurse (RN)

  • Required maintain required contact hours to fulfill regulatory requirements

  • Preferred Certified Case Manager (CCM)

  • Preferred Specialty - National certification in that area of specialty (in states where applicable)

Technical Skills:

  • Required intermediate Microsoft Excel

  • Required intermediate Microsoft Word

  • Required intermediate Microsoft Outlook

  • Required intermediate Healthcare Management Systems (Generic)


  • Bilingual helpful.