Employee Benefit Management Services, Inc.
  • 03-Jan-2018 to 04-Mar-2018 (MST)
  • CareLink
  • Billings, MT, USA
  • Full Time

Job Summary:

This position provides vision, leadership, planning, project coordination and management for the development of a cost-effective care management programs while concurrently facilitating efficient operations and enhancing quality and reducing the cost of care for clients in order to meet current and future business needs for EBMS. This position is responsible for analyzing and directing all function-related activities within the scope of EBMS' care management programs. This position demonstrates a high level of expertise in leadership and manages the department's operation and personnel in order to deliver a high level of service, quality performance and production.

Essential Duties and Responsibilities:

  1. Departmental Responsibilities
  • Establish care management priorities, systems design and objectives on the program goals, outcomes and ongoing evaluation.
  • Establish, support and monitor objective measures of performance standards related to the case and utilization management programs.
  • Responsible for the evaluation and management of care management contracts, consultants and vendors.
  • Oversee Training for case managers per CMSA guidelines
  • Assures training materials are current.
  • Assists with standardizing EBMS research and policy on new technology.
  • Provides guidance on claims benefit issues requiring upper-level decision-making.
  • Oversees departmental activities to ensure staff is skilled in applying URAC accreditation guidelines.
  • Partners with team members to identify prospects and ensure quality presentations to prospects in support of care management business objectives.
  • Develops annual budget and administers funds according to budget guidelines and strategic objectives.

          2.  Strategic Planning

  • Responsible for the development, communication and implementation of effective growth strategies and processes.
  • Stays abreast of the latest developments in care management programs and services and remains highly technically competent at all levels.
  • Provides strategic operational input and leadership on decision making issues affecting care management programs
  • Frequently analyzes staffing matrix and adjusts accordingly
  • Evaluates and ensures cost effective utilization of resources
  • Acts as a change agent leading processes that are inclusive of thoughtful and progressive project documentation that meet client needs and sustain a competitive advantage.
  • Collaborates cross-departmentally to determine the strategic goals for care management programs within broad outlines provided by the executive team. Through research and evaluation, recommends and plans service delivery to support and meet company objectives.
  • Provide support and oversight for client implementation to ensure customer satisfaction and retention.

          3.  Leadership

  • Guides and directs team member performance by setting clear goals and expectations and tracks progress against goals.
  • Develops a team that can effectively manage the delivery of services in collaboration with colleagues.
  • Oversees continuing education of team members.
  • Conducts regular performance evaluation of team members, providing ongoing feedback and coaching as necessary to achieve service, quality and production goals. Performs documented reviews in a timely manner.
  • Addresses and coaches team members on behavioral or performance problems and implements corrective action as necessary.
  • Explains and administers company policies.
  • Appropriately shares pertinent department and company information with team members in a timely manner.
  • Actively participates in hiring, discipline and termination of team members.

          4. Customer Service

  • Provides timely and thorough follow up with both internal and external customers.
  • Appropriately escalates difficult issues up the chain of command.
  • Acts as a role model in demonstrating the core values in customer service delivery
  • Quality Assurance
  • Serves on committees, work groups, and/or process improvement teams to assist in improving quality/customer satisfaction.
  • Recognizes and alerts appropriate member of the Executive Team of trends that fall outside of quality parameters.
  • Performs self quality monitoring in order to develop and execute plans to meet established goals.
  • Provides ongoing feedback to help optimize quality performance.
  • Collaborates with others and cross-departmentally to improve or streamline procedures.
  • Develops new or improves current internal processes to improve quality
  • This job description in no way states or implies that these are the only duties to be performed by this employee.  The employee will be required to follow any other instructions and to perform any other duties requested by his/her supervisor.

Minimum Qualifications:

Bachelor's degree in Nursing with current MT license, Master of Health Administration preferred

Professional certification(s) in related field of study

Minimum five years of clinical nursing experience with a minimum of three years of direct case management experience

Minimum of three years of supervisory experience with experience in management of multidisciplinary department

Experience in an URAC accreditation preferred

Working knowledge of computers and software including but not limited to Microsoft Office products

Demonstrated leadership, organizational, problem-solving, and analytical skills as well as detailed oriented

Ability to maintain the confidentiality of protected health information in compliance with HIPAA regulations. 

Strong written and oral communication skills

Demonstrated ability to work independently, prioritize workloads, multi-task and manage priorities in order to meet deadlines

Travel as needed.

 

Physical Demands & Working Conditions:

Work is indoors in an office environment with moderate noise. Intermittent physical effort involving lifting of up to 25 pounds, walking, and stooping, kneeling, crouching, or crawling is required.  A typical workday involves sitting, frequent use of a keyboard, reaching with hands and arms, and talking and hearing, approximately 70% of the time.  Approximately 30% or less of the time is spent standing.  Normal vision abilities required, including close vision and ability to adjust focus. 

Employee Benefit Management Services, Inc.
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