Program Manager Care Management

Responsibilities:

Act as primary point of contact for the Health Plan and outside entities participates in regulatory/contractual compliance activities, required reporting, Narrative reports and department audit activities. Position provides support to department Leadership and team to ensure program compliance.   

• Attends community and DHHS meetings related to department business need.
• Supports Care Managers, Mental Health (MH) Clinician and Substance Use Coordinator (SUD) in areas of issues impacting coordination of care, delivery of services, contractual/regulatory compliance.
• Works collaboratively with department leadership, Information Services and Regulatory Reporting on identifying required data for reporting, reviews Exhibit O/Contractual reporting data, conducts analysis of data for accuracy, researching errors in data, and develops recommendations. 
• Prepares reports and conduct analysis of operations / services as required by departmental, regulatory, and State requirements. 
• Assist in preparation, coordination, participation, and follow up of department audits, such as readiness review and External Quality Review Organization (EQRO) site visits/audits. 
• Participates in review and development of new and / or revised standard operating procedures (SOP) related to care management operations to ensure program compliance necessary to meet members’ needs, contractual and regulatory requirements. 
• Acts as a liaison with outside entities, community agencies, social service agencies, and hospitals to develop/maintain collaborative contact to meet members’ needs, build collaborative relationships, and contractual/regulatory requirements.
• Other duties as assigned to meet business needs of department.
   

Education/Experience:  

• Bachelor’s Degree required.
• 5 years’ experience in account management (general advertising/marketing or interactive advertising/marketing).
• Knowledge of Medicare/ Medicaid preferred.
• Current marketing license preferred.
• Proficiency in Microsoft Office. 
• Valid driver’s license and mode of transportation.