Job Summary:

The Manager of Outpatient Continuing Care is responsible for supervising and managing teams of personnel who support case management of various member populations in the outpatient or community setting. These populations include, but are not limited to special needs populations, members with complex needs and members with general case management needs. This position ensures compliance with NCQA, state, federal and other regulatory accreditation standards. The Manager of Outpatient Continuing Care responsible for consumer-directed services ensures oversight and is the chief liaison with the Fiscal/Employer Agent. This position focuses on all areas of consumer-directed services including patient pay payment issues, fraud allegations, and reporting suspected fraud, waste, and abuse.

Essential Responsibilities:

• Manages and directs case managers and support staff to ensure case management activities are applied in a consistent and effective manner.

• Oversees day to day activities of assigned staff, to include staff scheduling, caseload assignment and appropriate utilization of resources.

• Conducts case level reviews and provides feedback to staff on a regular basis.

• Ensures member benefits are interpreted and applied correctly and in compliance with state and federal regulations.

• Partners with other members of the UMOC and Continuing Care teams to develop and implement collaborative processes.

• Supports professional growth by providing education, training and appropriate resources.

• Conducts performance evaluations, provides coaching and acts as a mentor to direct reports.

• Performs other related duties as assigned.

Basic Qualifications:

Experience

• Minimum five (5) years of experience in a clinical setting.

• Minimum two (2) years of experience in Case Management.

• Minimum four (4) years of supervisory or management experience.

Education

• Bachelors degree in nursing, health care administration or related field required for RN candidates.

• Masters degree in social work required for LCSW candidates.

License, Certification, Registration

• This job requires credentials from multiple states. Credentials from the primary work state are required before hire. Additional Credentials from the secondary work state(s) are required post hire.

• Licensed Clinical Social Worker (Virginia) within 3 months of hire OR Compact License: Registered Nurse within 3 months of hire OR Registered Nurse License (Virginia) within 3 months of hire

• Registered Nurse License (District of Columbia) within 3 months of hire OR Licensed Social Worker (District of Columbia) within 3 months of hire

• Licensed Clinical Social Worker - Certified (Maryland) within 3 months of hire OR Compact License: Registered Nurse within 3 months of hire OR Registered Nurse License (Maryland) within 3 months of hire

Additional Requirements:

• Proficient in computer applications including Microsoft Word, PowerPoint and Excel required.

• Strong interpersonal skills, with good verbal and written communication skills required.

• Skills in problem-solving and collaboration with other professions/ disciplines required.

Preferred Qualifications:

• Experience working with various member populations in a community setting preferred.

• Working knowledge of or experience working with state Medicaid / Medicare plans preferred.

• For the consumer-directed services manager role, prefer candidate with a minimum of three (3) years of experience working in a consumer-driven service organization specifically focused on Medicaid and/or disabled and/or other vulnerable member populations preferred.

• Masters degree in nursing, health care administration or related field.

• Certification in Case Management from Commission for Case Manager Certification preferred.

COMPANY: KAISER

TITLE: Consumer Directed Services Manager - Virginia Medicaid

LOCATION: Hyattsville, Maryland

REQNUMBER: 1280047

External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.