When joining the Medicaid team, you are joining a large and passionate team. The individuals on this team have a love and passion for the work they do each day, and we are looking for a leader that has that same passion! This team is also very engaged as their Glint survey scores are always high. This team also focuses a lot on team building and gets together for team building events often. This is a great opportunity for a leader that is looking to have an opportunity to grow as well as grow within their knowledge of Medicaid. This individual would manage many different types of roles including community health workers within the community, clinical staff including RNs/ social workers, and medical coordinators. We are looking for an individual who has a background in care management as well as knowledge and background with Medicaid within the state of MI. This person would work more on the strategies moving forward for the team and setting goals, developing innovative partnerships as well as new programs. This person must have the knowledge to keep up on the changes as it relates to Medicaid in the state as well and make sure the team is always in compliance with them. Next year this team is planning to go STATEWIDE with this program and grow from 23 counties to all over the state.

Job Summary -

Provides supervision and leadership to the team of Priority Health Case Managers and support staff. Responsible for the operations and acts as a resource and consultant to the team to ensure that the goals and standards of the department and Priority Health programs are being met. Provides oversight of processes and procedures to assure that the individual's specific health needs are met to promote the highest quality of care in the most appropriate setting.

DIRECTION EXERCISED:

Directly supervises regional employees. Responsibilities include but are not limited to effective interviewing, hiring, and training employees; planning, assigning, and directing work, appraising performance; rewarding and counseling employees; addressing complaints and resolution.

Essential Functions -

• Departmental
  • Assures the integration of Priority Health Case and Disease Management operations inter- and intra-departmentally.
  • Develops and implements training modules for Case and Disease Management operations.
  • Develops and supports marketing materials for Case Management in conjunction with Sales and Marketing.
  • Program development: In conjunction with the Director, Care Management, determines the case and/or disease management needs for the new products/services.
  o Researches, analyzes and defines programs; develops the structure and key elements of the program.
  o Manages the development of the new programs from concept to implementation.
  o Provides post-implementation monitoring and oversight as assigned.
  • Serves as a contact/resource for internal and external customers re: Priority Health Case and Disease Management, including assisting with/participation in internal and external presentations, in conjunction with the Director, Care Management.
  • Ensures representation in internal and external committees that promote the goals and value position of the Priority Health Case Management team.
  • Participates in the development of measurable outcomes, ensures measures are in place to monitor the impact of programs and services on the health status of the member managed.
  • Demonstrates and utilizes knowledge of appropriate resources within the company, health care system and community.
• Leadership
  • Responsible for supervising, planning, administering and controlling activities of the Priority Health Case and Disease Management team.
  • Monitors the day-to-day operations of the Priority Health Case and Disease Management team to identify barriers to providing excellent service to Priority Health members.
  • Responsible for hiring, developing and evaluation of the staff of the Case and Disease Management team.
  • Provides leadership to the individuals responsible for the program operations including coaching and mentoring to direct reports.
  • Motivates departmental personnel assigned to the program to ensure program effectiveness.
  • Identifies opportunities for improvement and takes action.
  • Provides input into the development, implementation and evaluation of departmental goals and objectives.
  • Plans and implements orientation and training of new-hire employees.
  • Establishes priorities and goals for direct reports.
  • Delegates work to direct reports appropriately and effectively.
  • Systematically evaluates the quality and effectiveness of staff performance, analyzing appropriate data and information to identify areas of improvement; advises and coaches when appropriate and completes annual performance appraisals.
  • Performs (or oversees) quality review and audit of staff.
  • Participates in the review, revision and approval of policies and procedures. Accountable for compliance to policies and procedures pertaining to case management activities.
  • Effectively delegates activities associated with area of responsibility.
  • Participates in the development and implementation of best practices that further the Priority Health value position.
  • Ensures timely and accurate distribution of communications.
• Corporate
  • Participates in interdepartmental committees and/or workgroups that are pertinent to areas of responsibility.
  • Maintains knowledge and understanding of all regulatory and accrediting requirements pertinent to Priority Health Case and Disease Management.
  • Effectively intercedes with other employees/departmentsto resolve concerns related to staff or process.
  • Collaborates with the Director, Care Management to develop and implement Health Management Programs consistent with Priority Health’s overall strategy.
  • Focuses on results by seeking to constantly improve them. Collaborates with other managers in the Health Management department to ensure appropriate performance monitoring are occurring and action plans are developed as needed.
  • Assists Provider Services, Customer Service, and the Marketing department in their efforts to communicate Priority Health Case Management policies and procedures to providers, employers, and members.
  • Operates effectively within defined budget parameters.

Qualifications – Required:

• Required Bachelor's Degree or equivalent in health-related field
• 5 years of relevant experience clinical experience in health services setting Required

Qualifications – Preferred:

• Preferred Master's Degree for those who do not have MSW, MA or MS degree
• 3 years of relevant experience managed care and/or case management experience Preferred
• Strong knowledge of management health care Preferred
• Knowledgeable on compliance and regulations as it relates to Case Management Programs Preferred
• LIC-Registered Nurse (RN) - STATE_MI State of Michigan Upon Hire preferred Or
• LIC-Master Social Worker (MSW-Master) - STATE_MI State of Michigan Upon Hire preferred
• CRT-Case Manager, Certified (CCM) - CCMC Commission for Case Manager Certification preferred

Some of the benefits provided include:

• Medical, Dental, and Vision Benefits
• Life Insurance
• Short- & Long-Term Disability
• Paid Time Off & Holiday Pay
• Retirement Plans
• Discount Program
• Learning Opportunities
• Inclusion Resource Groups
• Manager Incentive Program

Apply now to learn more about joining a nationally known health system with an ambitious vision. We cannot do it alone. Our people are at the heart of what we do. Improve health. Inspire hope. Save lives.

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Spectrum Health is committed to providing a safe environment for our team members, patients, visitors and community. That is why we require a drug-free workplace and various vaccinations as a requirement for employment.

Spectrum Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, sexual orientation, veteran status, or any other legally protected category.

An interconnected, collaborative culture where all are encouraged to bring their whole selves to work, is vital to the health of our organization. As a health system, we advocate for equity as we care for our patients, our communities, and each other. From workshops that develop cultural intelligence, to our inclusion resource groups for people to find community and empowerment at work, we are dedicated to ongoing resources that advance our values of diversity, equity, and inclusion in all that we do. We invite those that share in our commitment to join our team.

If you are a qualified individual with a disability, you may request assistance in completing the application process by calling 616.486.7447. We are committed to granting reasonable accommodations in accordance with applicable laws.