The Care Management Supervisor is responsible for the community care management program overseeing the services provided by a team of community-based care managers and community health outreach workers. The care managers are responsible for assessing the members’ needs; and facilitating, promoting, and advocating for the member’s on-going self-sufficiency and independence, Additionally, the care managers are responsible for sustaining the natural supports of the member, offers person-centered care planning, service coordination, and support services for members receiving long-term care (LTC) and home and community-based services (HCBS). This includes, but is not limited to, assessing the availability of natural supports, representative or family members to ensure the on-going and physical and behavioral health of those natural supports.

All employees shall meet specified training programs including Compliance/Privacy Regulations, and attend at a minimum one (1) hour of Compliance/Privacy educational training annually, as required by Florida Community Care (FCC).

All employees shall meet Risk Management Regulations, and attend at the minimum one (1) hour of Risk Management education and training within the first thirty (30) days of employment and as required by law or Florida Community Care; and, for that non-physician in clinical direct care delivery services, annually thereafter.

All employees if duly licensed in the State of employment, and said license is part of requirement of their position with Florida Community Care, shall maintain in good standing and current state licensure.

All employees are required to maintain confidentiality, protect privacy, comply with PHI regulations, and report violations.

The Care Management Supervisor is responsible for the community care management program overseeing the services provided by a team of community-based care managers and community health outreach workers. The care managers are responsible for assessing the members’ needs; and facilitating, promoting, and advocating for the member’s on-going self-sufficiency and independence, Additionally, the care managers are responsible for sustaining the natural supports of the member, offers person-centered care planning, service coordination, and support services for members receiving long-term care (LTC) and home and community-based services (HCBS). This includes, but is not limited to, assessing the availability of natural supports, representative or family members to ensure the on-going and physical and behavioral health of those natural supports.

All employees shall meet specified training programs including Compliance/Privacy Regulations, and attend at a minimum one (1) hour of Compliance/Privacy educational training annually, as required by Florida Community Care (FCC).

All employees shall meet Risk Management Regulations, and attend at the minimum one (1) hour of Risk Management education and training within the first thirty (30) days of employment and as required by law or Florida Community Care; and, for that non-physician in clinical direct care delivery services, annually thereafter.

All employees if duly licensed in the State of employment, and said license is part of requirement of their position with Florida Community Care, shall maintain in good standing and current state licensure.

All employees are required to maintain confidentiality, protect privacy, comply with PHI regulations, and report violations.

Core duties and responsibilities include the following. Other duties may be assigned.

• In collaboration with the Leadership Team, assist in the development and implementation of community relations strategic plan. Build positive relationships with community and regulatory stakeholders.
• Directly manage all community outreach staff including, but not limited to, hiring, training, scheduling, monitoring workloads, conflict resolution, conducting performance evaluations, and implementing performance improvement and disciplinary actions, when necessary.
• Oversee workload needs on a concurrent basis including monitoring staff production metrics, auditing assessments and member plans of care according to respective policies and procedures. Daily prioritization of staffing assignments for optimizing impact on department production.
• Monitor the performance of the care management team members and provide constructive feedback and opportunities for improvement.
• Conduct regular evaluation of the care management program including, but not limited to, timely review of the member’s plan of care with the interdisciplinary team, collaborative review and reassessment of the members’ plan of care as defined and coordination of the member services.
• Responsible for coordination and presentation of information for administrative hearings and State reviews when applicable.
• Responsible for developing strong working relationship with the Care Management Staff and with other internal teams to encourage a cooperative sharing of ideas and support.
• Facilitate, promote, and coordinate post-acute care within the most appropriate care setting through on site care management activities in post-acute care facilities.
• Identify and track coordination of care and HEDIS and performance outcomes.
• Provide on-going coaching and counseling to all staff.
• Create culturally appropriate health education, information, and outreach in community-based settings.
• Monitor and track compliance with HIPAA regulations, professional conduct, and ethical practices.
• Assist in the development of multidisciplinary community training and education programs for internal and external customers.
• Provide guidance and direction to staff, identify performance issues; recommend/implement necessary steps for improvement; ensure fair corrective action procedures.
• Prepare performance evaluations/reviews; initiate salary increases actions.
• Ensure timely submission of attendance records to the Human Resources Department.
• Monitor attendance of Care Management Staff
• Assume accountability for department performance in Director’s absence

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Willingness to establish and maintain effective working relationships with others as a team by offering support and/or ideas to enable staff to reach goals.
• Willingness to keep abreast of current procedures and requirements.
• Practices core competencies of a manager including:

• • Visionary Leadership - Displays passion and optimism; Inspires respect and trust; Mobilizes others to fulfill the vision; Provides vision and inspiration to peers and subordinates.
  • Change Management - Develops workable implementation plans; Communicates changes effectively; Builds commitment and overcomes resistance; Prepares and supports those affected by change; Monitors transition and evaluates results.
  • Delegation - Delegates work assignments; Matches the responsibility to the person; Gives authority to work independently; Sets expectations and monitors delegated activities.
  • Leadership - Exhibits confidence in self and others; Inspires and motivates others to perform well; Effectively influences actions and opinions of others; Accepts feedback from others.
  • Managing People - Includes staff in planning, decision-making, facilitating and process improvement; Takes responsibility for subordinates' activities; Makes self available to staff; Provides regular performance feedback; Develops subordinates' skills and encourages growth; Solicits and applies customer feedback (internal and external); Fosters quality focus in others; Improves processes, products and services.
  • Quality Management - Looks for ways to improve and promote quality; Demonstrates accuracy and thoroughness.
  • Cost Consciousness - Works within approved budget; Develops and implements cost saving measures; Conserves organizational resources.
  • Ethics - Treats people with respect; Keeps commitments; Inspires the trust of others; Works with integrity and ethically; Upholds organizational values.

• Knowledge of AHCA, Florida Medicaid, NCQA, and AAAHC policies and procedures
• Knowledge of Managed care and healthcare industry and practices.
• Proficiency in Windows and Microsoft Office applications.
• Ability to manage multiple priorities.
• Ability to read, analyze and interpret the most complex documents.
• Ability to read, analyze, and interpret state and federal managed care guidelines.
• Ability to respond to common inquiries or complaints from members, physicians, regulatory agencies, or members of the business community.
• Ability to apply principles of logical or scientific thinking to a wide range of intellectual and practical problems.
• Excellent oral and written communication skills, bilingual preferred.
• Process-oriented with documentation and project management skills.
• Individual must show initiative and motivation and must demonstrate successful interpersonal relationship skills.

Care Managers shall meet one for the following qualifications:

• Master’s degree in a human service, social science or health field and has a minimum of two (2) years’ experience in care management, at least one (1) year of which shall be related to the elderly and disabled populations;

OR

• Bachelor’s degree in a human service, social science or health field with a minimum of five (5) years’ experience in care management, at least one (1) year of which shall be related to the elderly and disabled populations; Licensed Practical Nurse, licensed in the state of Florida

OR

• Professional human service, social science or health related experience may be substituted on a year-for-year basis for the educational requirement, (i.e., a high school diploma or equivalent and nine (9) years of experience in a human service, social science or health field, five (5) years of which shall be related to care management, at least one (1) year of which shall be related to elders and individuals with disabilities).

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is occasionally required to stand; walk; sit; use hands, reach with hands and arms; talk and hear. The employee must occasionally lift and/or move up to 10 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.

Must be able to work in a stressful environment.

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The noise level in the work environment is usually moderate.

In compliance with the Drug-Free Workplace Act of 1988, Florida Community Care has a longstanding commitment to provide a safe, quality-oriented and productive work environment. Alcohol and drug abuse poses a threat to the health and safety of FCC employees and members and to the security of the company's equipment and facilities. For these reasons, FCC is committed to the elimination of drug and alcohol use and abuse in the workplace.

This position requires up to 100% travel; typically travel is local during the business day.

Independent Living Systems, LLC, and its subsidiaries, including FCC, provides equal employment opportunity to all individuals regardless of their race, color, creed, religion, gender, age, sexual orientation, national origin, disability, veteran status, or any other characteristic protected by state, federal, or local law. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.