Team Lead, Care Management at Community Health Network of Connecticut Inc

Wallingford, Connecticut, United States -

Full Time

Start Date

Immediate

Expiry Date

24 Sep, 26

Salary

108100.0

Posted On

26 Jun, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Clinical Leadership, Case Management, Staff Supervision, Performance Management, Regulatory Compliance, URAC Standards, Workflow Optimization, Crisis Management, Patient Care, Staff Training, Audit Process, Resource Allocation, Communication Skills, Project Management, Nursing Care, Clinical Oversight

Industry

Insurance

Description

Community Health Network of Connecticut, Inc. (CHNCT) is currently seeking a Team Lead, Care Management to join our team. Primary Responsibilities: * Under the direction of the Manager, functions as clinical resource for the care managers and support staff (clinical and non-clinical). * Acts as a subject matter expert and ensures consistency in procedures and workflows. * Provides recommendations to improve efficiencies. * Monitors operational reports and team compliance with contractual, regulatory and URAC requirements. * Identifies and addresses training needs of staff. * Monitors staff performance and participates in the performance review process. * Responsible to work with the manager to ensure alignment with staffing and resource needs. * Participates in internal and external committees and collaborative meetings. Tasks Performed: * Responsible for day-to-day functions, including staff assignments, coverage of work queues, and fulfillment of contractual requirements. * Manages high acuity, sensitive cases, and carries small caseload of members (when designated to ICM); provides face-to-face visits with members when appropriate. * Provides oversight and coverage of the crisis queue as needed. * Coordinates case rounds and facilitates case reviews with designated plan medical director when indicated. * Under the direction of the Manager, reviews oversight, productivity and performance/outcome reports, and identifies trends and areas for improvement. * Assists with orientation and training of staff, and oversight of preceptorship. * Conducts ad hoc meetings with staff as needed to discuss new policies, workflows, and requirements. * Assists with the peer audit process including communication of results and development of corrective action plans as needed. * Participates in the performance review process, including the creation of performance improvement plans when needed and annual performance reviews. * Schedules employees, including authorizing overtime; tracks attendance and timecard accuracy; projects staffing for daily and future (PTO) needs. * Takes an active role in system implementations/upgrades, including testing and training, to ensure the needs of the business are met. * Represents CM team at designated Department of Social Services (DSS) meetings, committees, work groups and task forces as assigned. * Perform other duties as assigned. Essential Functions: * Acts as a leader and resource for clinical and non-clinical CM staff. * Monitors staff performance with an emphasis on compliance with contractual, regulatory, and URAC standards (as necessary). * Manages overall performance and provides positive recognition and progressive discipline as appropriate. * Assists in the evaluation of staff for conformity with policies and procedures, regulations, and professional standards. * Evaluates and completes performance evaluations. * Leads and motivates individuals, mentors' subordinate staff and facilitates problem solving. * Maintains regular contact with staff which includes regular one-on-one meetings with staff and other touch-base meetings. * Recommends and participates in implementation of changes to workflows, processes, and procedures to improve efficiencies and streamline unit functions. * Ensures compliance with quality and safety regulations and standards. * Will practice only within the boundaries of their license and competence level, based on their education, training, appropriate professional experience, and other professional credentials. Desired Education: Two to four years post-secondary schooling Desired Degree: Bachelor’s degree Desired Major: Nursing (required) Desired Job Experience: 3 to 5 years related experience, with a minimum of 2 years direct clinical care experience as an RN required. Prior case management experience in a managed care setting required; prior supervisory or team leadership experience a plus Other Qualifications: Excellent oral and written communication skills. Ability to communicate effectively with all areas of the company. Flexible and adaptable with ability to adjust to changing priorities and manage multiple projects concurrently. Proficient in Windows environment. Team player with proven people skills. Managed care experience preferred. Case management experience. CCM or other URAC approved certification required within 3 years of kiirect care management staff supervision (when designated to ICM). CT RN license must be current and unrestricted. Must hold a valid and unrestricted motor vehicle operator's license and have reliable transportation. CCM preferred or required within 3 years of hire. Certifications Required: Active Registered Nurse License, State Motor Vehicle license We are dedicated to having a workplace where everyone feels valued, respected, and empowered to succeed. We embrace a wide range of perspectives and backgrounds, ensuring fair treatment and opportunities for all employees. We value our team’s rich array of experiences and viewpoints, which contribute to our innovative and collaborative environment. We are committed to providing an inclusive and accessible interview process. If you require a reasonable accommodation for your interview due to a disability. Please contact us in advance if you need an accommodation.

How To Apply:

Incase you would like to apply to this job directly from the source, please click here

Responsibilities

Acts as a clinical resource and leader for care management staff, ensuring consistency in workflows and compliance with regulatory and URAC requirements. Manages day-to-day operations, including staff assignments, performance reviews, and the handling of high-acuity cases.