Join Martin's Point Health Care - an innovative, not-for-profit health care organization offering care and coverage to the people of Maine and beyond. As a joined force of "people caring for people," Martin's Point employees are on a mission to transform our health care system while creating a healthier community. Martin's Point employees enjoy an organizational culture of trust and respect, where our values - taking care of ourselves and others, continuous learning, helping each other, and having fun - are brought to life every day. Join us and find out for yourself why Martin's Point has been certified as a "Great Place to Work" since 2015. Position Summary The Supervisor is responsible for day-to-day operations of the Care Management Teams within the Health Management Department which could include clinical and non-clinical staff. Regularly monitors daily workload, intake and referral activities, metrics, production, and phone-calls. The supervisor ensures compliance with regulatory requirements, benefits, professional standards of practice, and timeliness standards for all lines of business. The Supervisor will maintain a detailed knowledge of applicable regulatory and accrediting body standards (i.e. American Nurses Association (ANA), Case Management Society of America (CMSA), National Committee of Quality Assurance (NCQA), and Centers of Medicare and Medicaid Services (CMS). Job Description Key Outcomes: + Leads daily team huddles and manages the day-to-day care management activities within the Health Management Department including but not limited to routine and complex care management, transitions of care, chronic care, behavioral health and maternity care management. + Manages the day-to-day care management activities within the Health Management Department including but not limited to case assignment, caseload management, and productivity oversight. + Completes clinical call and clinical documentation audits for the care management team. + Serves as a mentor and daily resource for team members and partner departments assisting with questions, complex cases or situations and escalates as appropriate. + Oversees initial and cross-training of care management team members on new programs and initiatives. + Responsible for onboarding new team members and provides support to the assigned preceptor. + Assists with the creation and maintenance of care management standard work including policies and procedures. + Participates in program planning and enhancements. Identifies improvement opportunities and participates in technology, system planning and enhancement; recommends and tracks technology modifications that support the care management processes. + Assists in performing care management in a clinical capacity as needed. + May serve as a clinical department representative in Health Plan committees, focus groups, and other operational interdepartmental initiatives. + Ensures compliance with and integrity of all departmental processes and policies, benefit interpretation and professional standards of practice, and maintains a detailed knowledge of applicable regulatory and accrediting body standards. + Conducts annual reviews and ensures effective staff development. Promotes care management staff engagement in organizational and strategic plans, goals and projects. + Makes supervisory decisions that are consistent with HR policies and procedures. Ensures CM staff have all required resources necessary to effectively perform assigned duties. + Collaborates with other department supervisors, managers and team members and MPHC Medical Directors to achieve departmental and organizational goals. + Identifies opportunities for process improvement and initiates or delegates projects. + Works closely with the Manager Care Management, Director Health Management, Utilization Review managers/ supervisors, Quality Department staff, medical director staff, and Compliance and legal counsel on a variety of departmental functions and issues, as necessary. + Works as a Care Manager in a back-up capacity as needed based on workload needs. Education/Experience: + Associate’s degree in nursing; bachelor’s degree (BSN) preferred. + 3 years of medical management experience in a managed care setting including Case Management and Disease Management + Demonstrated leadership/supervisory experience. Required License(s) and/or Certification(s): + Current Licensure as an RN in Maine and other appropriate jurisdictions as necessary + CCM required Skills/Knowledge/Competencies (Behaviors): + Demonstrates an understanding of and alignment with Martin’s Point Values. + Excellent interpersonal, verbal, and written communication skills + Critical thinking: can identify root causes and implement creative solutions; analyze and apply data to inform decision-making + Ability to demonstrate a clear understanding of the standards of professional practice in decisions, leadership, and documentation + Ability to prioritize time and manage multiple competing demands efficiently and effectively for self and others + Ability to function independently + Computer proficiency in Microsoft Office products including Word, Excel, and Outlook There are additional competencies linked to individual contributor, provider and leadership roles. Please consult with your leader to discuss additional competencies that are relevant to your position. This position is not eligible for immigration sponsorship. We are an equal opportunity/affirmative action employer. Do you have a question about careers at Martin’s Point Health Care? Contact us at: jobinquiries@martinspoint.org