Complex and Disease Case Management Manager

$91,200 - $117,920/Yr

Kaiser Permanente - Atlanta, GA

Full-time - Manager

Hybrid - Atlanta, GA

Ambulatory Health Care Services

About the position

The Complex and Disease Case Management Manager is responsible for overseeing the Complex and Disease Specific Case Management Program and Social Services. This role involves managing case management activities across various product lines, ensuring compliance with regulations, and fostering a culture of continuous improvement and ethical standards within the organization. The manager will supervise staff, develop policies, and collaborate with healthcare professionals to enhance care coordination and outcomes for high-risk members.

Responsibilities

• Monitor and oversee case management activities and outcomes across all product lines.
• Collaborate with healthcare leaders to create positive outcomes for high-risk members.
• Accountability for identifying and implementing case management quality initiatives.
• Develop and implement quality improvement plans and disease-specific programs.
• Supervise non-physician case management supervisory staff.
• Evaluate candidates for hiring in accordance with departmental goals.
• Develop and implement policies and procedures for case management.
• Ensure regulatory compliance in case management activities.
• Educate staff and physicians on relevant regulations and changes.
• Prepare for MDQR and NCQA site visit reviews.
• Assist with problem-solving and difficult cases as a lead resource for staff.
• Identify training needs and participate in staff education and training.
• Provide analysis of department statistics and activities to the Director.
• Analyze reports to improve resource utilization.
• Interact with other QRM managers to solve problems and assist with difficult cases.
• Determine staffing requirements for effective case management services.
• Develop performance objectives for management staff and ensure competence meets standards.
• Build effective relationships with physicians, hospital staff, and vendors.
• Conduct interviews, training, evaluations, and disciplinary actions in compliance with policies.
• Attend healthcare team meetings and Hospital Analysis Work Group Meetings as needed.
• Collaborate with other managers to ensure continuity of care.
• Assist in QRM staff meetings and identify inefficiencies in existing systems.
• Recommend revisions of service area criteria and goals as needed.
• Plan and participate in the orientation of newly contracted providers and facilities.
• Represent the Georgia market in interregional activities as necessary.
• Work cross-functionally with other departments to meet organizational goals.
• Participate in Marketing RFI/RFP processes as requested.
• Act as a team coach for customer service and staff productivity.
• Develop and manage the budget for areas of accountability.
• Maintain knowledge of relevant regulations and documentation requirements.
• Support compliance with organizational policies and procedures.
• Investigate and report compliance issues and concerns.

Requirements

• Minimum five (5) years of case management and/or disease management supervisory experience.
• Bachelor's degree (BS) in nursing or four (4) years of experience in a directly related field.
• Registered Professional Nurse License (Georgia).
• Case Manager Certificate within 12 months of hire.
• Working knowledge of all federal, state, local and regulatory requirements.
• Functional knowledge of computers and medical management applications.

Benefits

• Flexible work location options (on-site and remote)
• Competitive salary range of $91,200 - $117,920 per year
• Full-time employment with a standard 40-hour work week
• Comprehensive health benefits
• Retirement savings plan options
• Professional development opportunities