ToC Manager (RN) at Maryland Care Management Inc

Linthicum, Maryland, United States -

Full Time

Start Date

Immediate

Expiry Date

27 Apr, 26

Salary

0.0

Posted On

27 Jan, 26

Experience

5 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Care Management, Coordination, Continuity, Accessibility, Utilization, Health Outcomes, Engagement, Presentation Skills, Training, Microsoft Office, Clinical Nursing, Managed Care Programs, Regulatory Requirements, Performance Management, Budget Development, Patient Confidentiality

Industry

Insurance

Description

Description Summary/Position Objectives: This position is responsible for oversight of the planning, development, implementation, and evaluation of Care Management (CM) programs. The Manager of TOC is responsible for ensuring that staff follow the care management process as defined, which involves improving coordination, continuity, accessibility, and the appropriate utilization of healthcare services and community resources for high-risk and special needs members. This process aims to enhance health outcomes and engagement in health-seeking behaviors. About Maryland Care Management, Inc. (MCMI) Maryland Care Management, Inc. (MCMI) manages Maryland Physician Care's (MPC) statewide provider network of hospitals and physicians. Maryland Physicians Care has been providing services to the HealthChoice Medicaid populations since 1996, and we are proud of our footprint in the community. With over 230,000 members, MPC consistently has been one of MD's largest Medicaid-managed care organizations. Why join us? MCMI recognizes the importance of flexibility and offers multiple work arrangements. Along with competitive pay, we offer excellent benefits (medical, dental, and vision plans, 100% employer Term Life Insurance, Short and Long-Term Disability, 401k Employer Match up to 4%) as well as 20 days of PTO, and tuition assistance/professional development plans. Your future colleagues at MCMI are welcoming, friendly, and eager to help each other succeed. We are committed to Diversity, Equity, and Inclusion, providing organizational-wide social opportunities, and constantly improving our ongoing efforts to positively impact our members' lives. What You'll Do: Provide oversight of Transition of Care programs. Responsible for recruitment support and selection of appropriate staff, and prepares for timely employee performance evaluations. Promote individual and team development and provide performance management, when necessary. Prepares reports on key indicators and activities for committees and senior management. Collaborates with the Director of CM on the development of the annual budget and operates within the approved budget. Collaborate with interdisciplinary teams to support staff in the coordination of care activities. Serves as a resource for health plan information and helps to integrate care management functions throughout the health plan. Assists in the annual development of measurable goals for care management programs based on data from outcomes reports, quality indicators, regulatory agencies, and health plan initiatives and priorities. Implement ongoing development and education of care management staff. Ensures that program integrity and regulatory requirements are met in conjunction with the Director of CM. Secondary Functions: Communicates regularly with employees through staff meetings to share company, health plan, and department information appropriate to their job function. Responsible for development, implementation, and annual review of care management policies and desktops. Maintains and promotes patient confidentiality, adhering to HIPAA regulations. Requirements Knowledge and Skills: Demonstrated skills for presentations and training before small and large groups. Knowledge of local health care delivery system. The ability to successfully utilize Microsoft Office suite and common computer and office hardware. Education and Work Experience: Registered Nurse with current State license (in good standing) Bachelor of Science in Nursing (BSN) 2+ years of management/supervisory experience 2+ years of clinical nursing in an acute care or community setting 3+ years of care management experience. Knowledge of MCO/Managed care programs (preferred) CCM Certification (preferred) Positions Reporting: Care Managers Social Workers Care Coordinator Community Health Worker

Responsibilities

The ToC Manager is responsible for overseeing the planning, development, implementation, and evaluation of Care Management programs. This includes ensuring staff follow the care management process to improve healthcare service utilization for high-risk members.