Assistant Manager-Healthcare Operations Management-Case Management Nursing

• Oversees the implementation of Highmark Clinical Case Management Support including but not limited to Case Management (CM) screening/Telephonic Outreach/Program Enrollment/Task Support for Case Management and monitors daily performance to ensure business goals are met and compliance with Highmark policies and procedures is maintained
• Implements clinical policies & procedures in accordance with NCQA, URAC, state and federal standards and mandates
• Serve as a content model expert and mentor to the team regarding practice standards, quality of interventions, problem resolution and critical thinking
• Ensure implementation and monitoring of best practice approaches and innovations to better address the member's needs across the continuum of care
• Protects the confidentiality of member information and adheres to company policies regarding confidentiality
• Manages resources responsible for identification of members, development and implementation of care plans, enhancement of medical appropriateness and quality of care and monitoring
• Communicates productivity expectations, balance workload (e.g., daily team meetings to discuss new referrals), monitor efficiency and initiate control measures to minimize variances in workload over time
• Ensures the team's understanding and use of information system capability and functionality
• May have responsibility for their own case load work

• Select staff using clearly defined requirements in terms of education, experience, technical and performance skills
• Assesses developmental needs and collaborates with others to identify and implement action plans that support the development of high performing teams
• Establish an environment and work style that promotes the concept of teamwork, cross product integration, and continuum of care thinking that results in strong performance
• Articulate performance expectations and team objectives while collecting and interpreting balanced measure to evaluate individual staff and team performance
• Lead change efforts while managing transitions within a team
• Create a positive work environment by acknowledging team contributions, soliciting input, and offering personal assistance when needed
• Accountable for maintaining compliance with Human Resource policies and procedures and implements them at the employee level
• Sedentary work involving periods of sitting, talking, hearing, work requires visual acuity to perform close inspection of handwritten and computer-generated documents as well as a PC monitor
• Typical office working environment

EXL Service