Company :Highmark Inc.Job Description : 

JOB SUMMARY

This job manages a team of Community Housing Coordinators (CHC) and Community Health Workers (CHW) who will support members with Social Determinant of Health Needs. This position will support staff to promote better member health outcomes through optimizing benefit utilization and connection to social resources and navigation of the healthcare system. This role provides direct oversight of the CHC and CHW team and assists in the day-to-day responsibilities as needed including documentation audits and caseload management. Experience as a Case Manager preferred. This is a full-time remote position with occasional travel required.

ESSENTIAL RESPONSIBILITIES

Manage and coordinate all department activities; staff education, policy and procedure development and revision, individual staff audits, oversees overall operations to ensure compliance to standards. Ensure appropriate distribution of workload; monitors/tracks staff completion of assigned work.Develop and implement modifications needed, to workload plan, to ensure completion and appropriately coach/counsel staff.Act as a  role model to staff and be able to assist in the day to day activities as needed. Provide service support, training and performance metrics/statistics, to the team, in addition to initiating and implementing process improvements. Recruit, select, orient, evaluate, counsel, and develop performance improvement plans; promote and terminate per corporate policy; and encourage career development and support of staff.Identify and escalate issues appropriately.Apply clinical knowledge to work with facilities and providers for care-coordination.Plan for and conduct staff meetings that assure corporate and operational communication supported by meeting minutes; and provide an open forum for issues and problem solving.Suggest new approaches to complex problems.Appropriate targets, measure outcomes and establish plan to negate variances in quality, staff retention, finance and customer satisfaction. Provide direct reports with guidance and educational tools in order to ensure compliance with NCQA, URAC, DOH, DOL and CMS.Review and provide input into the oversight of policies and procedures to support regulatory requirements related to Case Management. Develop and implement appropriate audit requirements in order to ensure compliance with all staff activity related to Case Management.  Ensure that all staff achieves the minimal qualification of their position through ongoing staff development, counsel and motivate employees, evaluate employees, investigate complaints or performance concerns; implement disciplinary action as needed and in consultation with appropriate authority and Employee Relations.Display effective communication skills.Maintain consistent and open lines of communication with internal and external customers.Communicate changes in processes and programs in order to enhance a share vision and mission.Effectively communicate outcomes, data analysis, complex processes and action plans to division/unit staff, corporate partners, and external customers. Facilitate and lead informational and educational meetings for internal and external customers.Accountable for special projects and enhanced activities within the department.Participate in the development and implementation of department/division projects. Implement integration processes and planning activities. Other duties as assigned or requested.

QUALIFICATIONS

Required

High School Diploma or GEDCurrent license in one or more of the following disciplines: RN, LCSW, LSW, LPC, or other related clinical license5-7 years of clinical experience3-5 years of experience in case management/managed care

Substitutions

None

Preferred

Two years of supervisory or managerial experienceCertified Case Manager (CCM)Licensed Bachelors Social Worker (LBSW)Licensed Masters Social Worker (LMSW) 
Licensed Clinical Social Worker (LCSW)Community Health Worker (CHW)Experience working with behavioral health populationMedicare and Medicaid experienceManaged care experience

    

Skills  

Leadership skills and be able to relate to all levels of management and staff as well as individuals external to the corporationLeadership, collaboration, and motivational skillsAbility to multitask and perform in a fast paced, and often intense environmentExcellent written and verbal communication skillsAbility to analyze data, measure outcomes and develop action plansTeam player that possesses strong analytical and organizational skillThe ability to prioritize work demands and meet deadlinesProficiency in PC-based word processing and database documentation (Word, Excel,     Internet, Outlook)Reliable transportation daily to be able to travel within assigned territoryAbility to meet regulatory deadlines.Has a dedicated home work space used only for business purposes and is able to comply with all telecommuter policiesUnderstanding of the importance of cultural competency in addressing targeted populations.Experience with electronic documentation system(s)Experience with cost neutrality and budgeting

SCOPE OF RESPONSIBILITY 
Does this role supervise/manage other employees?

Yes

WORK ENVIRONMENT
Is Travel Required?
Yes

Position Type:

Office Based

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement: This position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times.  In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. 

Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Pay Range Minimum:

$67,500.00

Pay Range Maximum:

$126,000.00

Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations.  The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.

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For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org

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