The Clinical & Complex Care Supervisor supports the leadership of the Clinical & Complex Care program. This role provides direct supervision of a team of licensed and non-licensed staff providing team-based care including, supporting members with complex needs transitioning from acute care homes or institutional type care, addressing barriers that impede improved community tenure with the support of network providers and community social service agencies, and providing supervision to licensed staff including Registered Nurses and Occupational Therapist, who complete medical data reviews and face to face assessments on members who qualify for Transition to Community Living.
This position is full-time remote. Selected candidate must reside in North Carolina and available to travel for onsite meetings as required.
This position will support staff who are involved in the Transition to Community Living program. These members may have both multiple complex physical health and behavioral health diagnosis. These members have community referrals that often have significant nurse involvement.
Responsibilities & Duties
Oversee Team Operations
Participate in the initiation, development, and maintenance of clinical protocols and other population-based programs, facilitating collaboration and consensus of multidisciplinary teams as complete care is developed
Make recommendations on the development of department specific goals and objectives ensuring alignment with system strategy, vision, mission, and values
Participate in the process to formulate, implement, and evaluate strategies for specialized staff education as it relates to member care, case management and plans of care
Must attend meetings or committees as appropriate to provide consultation, recommendations, or representation as it relates to members physical health and well-being
Complete case reviews of high risk/acuity cases in routine supervision meetings including interdepartmental problem solving, as well as organizational subject-matter experts (SME) where member specific requests for service authorization or case escalation reviews are anticipated
Ensure all aspects of the Olmstead Settlement is followed to allow members to remain successful and stable in the community setting of their choice
Problem-solve with the Manager -Clinical & Complex Care, Provider Network Department as well as organization subject-matter experts (SME) where member specific requests for service authorization or case escalation reviews are active or anticipated
Monitor completion of service monitoring assessments in Jiva. Promote trends of concern(s) to Director of Integrated Health Care Management, Provider Network and Evaluation department
Promote efficient and person-centered care management in compliance with all waiver requirements
Supervise and Develop Staff
Work with Human Resources and Manager to maintain and retain a highly qualified and well-trained workforce
Ensure staff are well trained in and comply with all organization and department policies, procedures, business processes and workflows
Ensure the department has the needed tools and resources to achieve organizational goals and to support employees and ensure compliance with licensure, regulatory, and accreditation requirements
Actively establish and promote a positive, diverse, and inclusive working environment that builds trust
Ensure all staff are treated with respect and dignity
Ensure standards are transparent and applied consistently, impartially, and ethically over time and across all staff members
Work to resolve conflicts and disputes, ensuring that all participants are given a voice
Set goals for performance and deadlines in line with organization goals and vision
Effectively communicate feedback and provide ongoing coaching and mentoring to staff and support a learning environment to advance team skills and professional development
Cultivate and encourage efforts to expand cross-team collaboration and partnership
Collaborate and Provide Conflict Resolution
Develop strong working relationships with providers and internal/external stakeholders by scheduling ongoing opportunities to share feedback and collaborate
Exercise conflict resolution skills to appropriately resolve issues with providers and internal/external stakeholders
Develop strong working relationships among the department and provide customer services with providers and stakeholders internal/external by scheduling ongoing opportunities to share feedback and collaborate
Monitor Outcome Measures Using Quality/Data/Analytics
Review, validate, and interpret risk stratification data and population health groups and recommend changes or adjustments to care management approach as needed
Monitor outcome measures for members and program as specified through Quality Improvement Plans and other initiatives as assigned
Utilize data systems to monitor process improvement and resource utilization. Formulates, implements, and evaluates strategies for specialized staff education as it relates to member care, case management and plans of care
Knowledgeable of HEDIS measurements and population health within a complete care model
Utilize evidence-based practice to ensure quality outcomes for members
Minimum Requirements
Education & Experience
Bachelor’s Degree in Nursing from an accredited college/university and three (3) years of post-degree experience with at least two (2) years of applicable experience with the population served, including Supervisor experience with case management/discharge planning in one of the following settings: Acute care, Home care, LTC care, Physician Office or Managed Care.
Or
Master’s Degree in Occupational Therapy from an accredited college/university and three (3) years of post-degree experience with at least two (2) years of applicable experience with the population served, including Supervisor experience with case management, discharge planning in one of the following settings: Acute Care, Home Care, LTC, Physicians office or Managed Care
Registered Nurse license in the state of NC or Occupational Therapy-license in the state of NC required.
Knowledge, Skills, & Abilities
Ability to access and interpret information and propose solutions to address issues and specific consumer needs and situations.
High level of diplomacy and discretion
Ability to effectively negotiate and resolve issues with minimal assistance.
Exceptional interpersonal skills
Ability to communicate effective orally and written
Ability to make prompt, independent decisions based on relevant facts
Problem solving, negotiation, and conflict resolutions skills
Highly skilled at assuring that both long- and short-range goals and needs of the individual are addressed and updated, while also assuring through monitoring activities that service implementation is occurring appropriately.
Salary Range
$70,875.00 to $118,125.00/Annually
An excellent fringe benefit package accompanies the salary, which includes:
Medical, Dental, Vision, Life, Long Term Disability
Generous retirement savings plan
Flexible work schedules including hybrid/remote options
Paid time off including vacation, sick leave, holiday, management leave
