Who we are:
Meridian, a WellCare Company, is part of a national network of passionate leaders, achievers, and innovators dedicated to making a difference in the lives of our members, our providers and in the healthcare industry.
We provide government-based health plans (Medicare, Medicaid, and the Health Insurance Marketplace) in Michigan, Illinois, Indiana, and Ohio. As a part of the WellCare Family of companies, we deliver healthcare excellence to millions of members nationwide.
Our associates work hard, play hard, and give back. Meridian associates enjoy an exceptional experience and culture including special events, company sports teams, potlucks, Bagel Fridays, and volunteer opportunities.
A Day in the Life of a Manager of Care Coordination:
This position has direct supervision over the Care Coordination teams and is responsible for providing leadership, direction and implementation of all aspects of the Care Coordination program. The Manager is responsible for ensuring the integration of evidence based clinical guidelines into member interventions; providing staff education both individually and on a group level; and serves as the liaison for staff with the Corporate Care Coordination team.Responsibilities
- Directly manage all staff including, but not limited to, hiring, training, scheduling, monitoring workload and staff expenses, conflict resolution, team meetings, conducting performance evaluations, and implementing performance improvement and disciplinary actions, when necessary
- Provides oversight of Team Leads to ensure compliance with program responsibilities and staff management
- Will ensure collaboration amongst all Care Coordination roles including both remote and local staff
- Possesses knowledge of contractual, accreditation, federal and business requirements for assigned program and will ensure compliance with program requirements and develops corrective action plans as needed
- Escalates concerns and reports any changes to the Program Leadership Team as appropriate for their assigned program
- Coordinates, monitors, and evaluates the activities of the various Care Coordination teams involved in managing the care of members based on information provided to them by the Corporate Care Coordination team
- Acts as a subject matter expert in the review of policies and procedures, program descriptions and evaluations developed by the Corporate Care Coordination team
- Establishes multiple case finding mechanisms and population specific assessment tools, identifies and assesses individuals through Predictive Model with catastrophic, complex or chronic risk factors who meet established criteria for entry into the Care Coordination program
- Will work to resolve all grievances, state complaints, member issues and case escalation follow up in a timely manner
- Review care coordination processes and key performance indicators to provide Senior Manager/Director with an individual assessment of compliance risk, internal control and the overall effectiveness and efficiency of the process
- Collaborates closely with the Quality Management, Utilization Management, Member Services, Pharmacy, Claims, and Provider Services to ensure access to care for all members serviced by the Care Coordination program
- Seeks out opportunities to participate in and improve HEDIS, CAHPS, National Committee for Quality Assurance (NCQA) or general accreditation and QIA initiatives
- Consistently demonstrates compliance with HIPAA regulations, professional conduct, and ethical practice
- Some travel may be required
- Perform other duties as assigned
What you can bring to Meridian:
- Bachelor’s degree in nursing, social work, counseling, health care administration or related field or Fellow, Academy of Healthcare Management (FAHM) is required
- Current licensure as a nurse or social worker in the designated state is preferred
- Master’s degree in nursing, health care administration or related field preferred
- 3 to 5 years’ experience in management of community-based program/agency, project management, health promotion, and assessments, or program development
- Experience in discharge planning, home health care, community health or managed care is required
- Minimum of 4 years of progressive management experience is preferred
- Advanced knowledge and experience in health care management
- Knowledge of managed care
- Knowledge of the Care Coordination process including tools and techniques for identification, stratification and management of high-risk clients
- Excellent organizational and critical thinking skills
- Excellent customer service and interpersonal communication skills
- Excellent written and verbal communication skills
- Ability to provide leadership and garner commitment to team function
- Ability to manage multiple tasks simultaneously
- Ability to work collaboratively and effectively with diverse groups
- Ability to function as part of an interdisciplinary team
What Meridian can offer you:
- Our healthcare benefits include a variety of plans that are effective on the first day of employment for our new full-time team members.
- Opportunity to work with the industry’s leading technologies and participate in unique projects, demonstrations, conferences, and exclusive learning opportunities.
- Meridian offers 401k matching that is above the national average.
- Full-time Meridian employees are eligible for tuition reimbursement towards Bachelor’s or Master’s degrees.
- Meridian was named Detroit's #1 Fastest Growing Company by Crain's Magazine, so it is a great time to get involved with Meridian.
Equal Opportunity Employer