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Clinical Team Manager- RN

 

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Centers Care Solutions (CCS), is a Managed Care Organization servicing members with Medicare and/or Medicaid.Our goal is to provide members and all those involved in their care with the guidance and health plan choices they need for healthy living. CCS is committed to providing quality, coordinated health care to some of the most honored and yet still vulnerable members of our community

JOB SUMMARY:

The Clinical Team Manager/FIDA responsible for the day-to-day operation and performance of FIDA program Care Management department within the compliance with CCS business products policies, procedures and all regulatory mandates, consistent with health plan mission, vision, purpose and value statements.

 

The Clinical Team Manager/FIDA is responsible for continuously improving the effectiveness and efficient operations of the FIDA program Care Management Department.  The incumbent will continuously audit charts and files to ensure that documentation meets NCQA regulations.  Incumbent will also function as a resource for the leadership staff to maximize quality of standards of care and appropriate utilization resources.

 

 

PRIMARY RESPONSIBILITIES:     

  • Manages clinical staff (Supervisors, Care Managers, and Social Workers) and non-clinical Care Coordinators staff (that supports clinical functioning) and associated activities in compliance with State and Federal regulatory requirements CCS policies and procedures.
  • Assigns member case to Care Managers based on geographical area and member cultural and linguistic preferences. Monitors individual case loads.
  • Continually monitors timeliness and appropriateness of documentation including but not limited to comprehensive assessments, person-centered service plan, care plan,  in care management data system and where appropriate (i.e. HCS-UASNY) to ensure that documentation meets State and Federal regulatory standards and CCS policies and procedures.
  • Continually monitors timeliness and appropriateness of Interdisciplinary Team Meetings (IDT) in compliance with the State and Federal requirements and CCS policies and procedures.
  • Continuously conducts audits of clinical records.
  •  Monitors employees’ performance, key performance indicators, audits, case reviews, etc.  Performs corrective action and/or counseling as needed.
  • Trains employees in process operations and acts as a preceptor to newly hired staff.  Completes staff    evaluations as needed and other duties as assigned.

 

EXPERIENCE:    

  • Knowledge of current community health practices for the frail adult population, behavioral health and cognitively impaired seniors and disabled including knowledge of physical health, aging and loss, appropriate support services in the community, frequently used medications and their potential negative side-effects, depression, challenging behaviors, Alzheimer’s disease and other disease related dementias.
  • Understanding of and sensitivity to members cognitive ability, means of communication and cultural differences and needs of the community are essential.
  • Knowledge in management and oversight of personnel.

                       

REQUIRED:   

  • Graduate of a 2- 4 year accredited nursing program;
  • Active and unrestricted NYS RN license
  • Minimum 5-8 years clinical experience
  • Excellent written and verbal communication skills.
  • Proficiency in the use of Microsoft Office tools
  • Strong problem-solving ability
  • Managerial experience

 

PREFFERED: 

  • Bachelor of Science in Nursing or Advanced Degree
  • CCM certification
  • Knowledge of UAS-NY assessment
  • Bilingual

 

 

 

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