Manager Integrated Care Management (must reside in FL)

Location: Palm Beach Gardens, FL

Primary Job Function: Medical Management

ID**: 31533

Job Brief

In anticipation of future business needs we are seeking an experienced Manager Integrated Care Management to support AmeriHealth Caritas Florida. Candidates must reside in Florida. Medicaid experience a must.

Your career starts now. We are looking for the next generation of health care leaders.

At AmeriHealth Caritas, we are passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we would like to connect with you.

Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.

Discover more about us at www.amerihealthcaritas.com.

Responsibilities:

Under the supervision of the Director ICM, the Manager of ICM is responsible for the direct performance of Case Management Responsible for compliance with State and Federal laws and business plan goals.

• Plans, organizes and directs the development and implementation of Case Management. Ensures staff is properly trained, oriented and provided with regular professional development. Identifies opportunities for improvement, both clinical and administrative, and assists the Director in the strategic planning processes for these functions.

• Coordinates and implements the development of recommended policies and programs. Coordinates, establishes and monitors achievement of departmental goals and objectives. Responsible for achievement of assigned NCQA standard compliance and compliance with all applicable State and Federal laws, as well as achievement of assigned incented health outcomes.

• Directs effectiveness of existing programs and services, identifies and evaluates new programs and services to address cost effectiveness, proposed process improvements and to achieve compliance with NCQA and State incented health outcomes.

• Participates in and supports the corporate Medical Management Strategy.

• Directs the case management activities to be in compliance with the Medicaid Model for case management.

• Develops and recommends a consolidated operating budget and submits to Director for approval. Reviews and authorizes disbursement of funds in accordance with operating procedures. Monitors monthly financial statements for areas of responsibility to determine and recommend adjustments.

• Directs the coordination of positive inter and intra communication to share information regarding quality of care, member issues and cost effective services. Works across departmental lines to achieve objectives.

• Creates and supports an environment that fosters teamwork, cooperation, respect and diversity. Establishes and maintains positive communication and professional demeanor with AMFC employees, providers and acts as liaison with outside entities as required. Demonstrates and supports commitment to corporate goals and mission.

• Performs other related duties and projects as assigned.

Education/Experience:

• Bachelor’s degree in Nursing or Social Work required.

• Master’s degree or equivalent experience preferred.

• Active and unrestricted Florida RN license, or current unrestricted Florida Social Work License.

• 8+ years of progressive experience in healthcare delivery required with at least 5 years of experience in managed health care/Medicaid.

• Minimum of 5 years managerial experience required.

• Minimum of 1 year project management experience required preferably at management level.

• Excellent organizational, analytical and interpersonal skills required.

• Ability to develop and design programs to address cost efficiencies and quality health outcomes.

• Ability to develop and maintain operational budget.

• Excellent written and verbal communication skills.

• Proficient PC skills in a windows based environment.

• Must have the ability to travel periodically for business needs.

• This requisition is in anticipation for future hiring state-wide. Ideally, applicants should reside in AHCA Regions G & I (Palm Beach & surrounding counties & Miami-Dade & Monroe counties). Also AHCA Regions D & E (Tampa & Orlando Metros).

Diversity, Equity, and Inclusion

At AmeriHealth Caritas, everyone can feel valued, supported, and comfortable to be themselves. Our commitment to equity means that all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. We stand together to speak out against injustice and to break down barriers to support a more inclusive and equitable workplace. Celebrating and embracing the diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve. We keep our associates happy so they can focus on keeping our members healthy.

Our Comprehensive Benefits Package

Flexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more.

EOE Minorities/Females/Protected Veterans/Disabled