Manager of Delegated Care Management

• Sep 2018 - Present

Field Assessment Assistant Manager

• 2018 - Sep 2018

Clinical Team Manager

• Feb 2017 - Mar 2018

Manages Care Management Supervisors, clinical staff (Care Managers and non-clinical staff Care)Coordinates (that supports clinical functioning) and associated activities in compliance with State regulatory standards and CPHL 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, member care plan, member contacts, etc. in care management data system and where appropriate (i.e. HCS-UASNY) to ensure that documentation meets State regulatory standards and CPHL policies and procedures.Continually conducts and leads member case conferences with Care Management Team (CMT)Continuously conducts audits of clinical records and provides analysis of the findingsMonitors 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.Complies with all CPHL’s standards of care and reports/documentation submissionParticipates in on call schedulingLeads monthly and as needed meetings with MLTC CM staff;Participates in other meetings as requestedMonitors employee’s attendance and requests for PTO and assists with timely payroll submission.Participates in quality improvement initiativesParticipates in MLTC CM Policy and workflow process development and implementation

RN Care Manager

• May 2015 - Feb 2017

Provides case management through telephonic care management, care planning, implementation, care coordination, monitoring, and evaluation to ensure member receives services and supports required to meet medical, behavioral health, psychosocial, educational and cultural care needs.Develops, facilitates, and communicates a person-centered plan of care in active participation with the member, his/her significant other, primary caregiver, the primary and attending physicians, assessment nurse and various other members of the IDT involved in the member’s care.Identifies member-specific barriers, issues, and interventions to assist and educate the member in meeting short and long term plan of care goals and requests authorization for services based on agreed upon member care planOngoing monitoring of member status, review of member UASNY assessments and clinical documentation, appropriateness of person-centered care plan and services in coordination with the interdisciplinary teamLeads and maintains ongoing two-way communication with members of Interdisciplinary team: the member, assessment nurse, member PCP, other specialists, home care and other community providers to assist in development of member centered care plan and monitor status.Acts as an advocate for members and their families linking them to other members of the interdisciplinary team to help them gain knowledge of their disease process and to identify community and other resources to improve and/or maintain maximum level of independence.