• Job Description

  Req#: MGRTP002669

  Who we are

  Community Health Plan of Washington is an equal opportunity employer committed to a diverse and inclusive workforce. All qualified applicants will receive consideration for employment without regard to any actual or perceived protected characteristic or other unlawful consideration.

  Our commitment is to: · Strive to apply an equity lens to all our work. · Reduce health disparities. · Create an equitable work environment.

  About the Role

  Provides clinical and operational leadership to the Third Party Administrator (TPA) Care Management team. Responsible for daily oversight of the delivery of care management and transition of care services to justice involved individuals with a range of physical health, behavioral health and social service needs. Ensures collaboration between internal and external partners to effectively transition members across the continuum of care. Ensures Care Management programs and processes align with applicable regulatory standards. Collaborate with carceral facilities to integrate services and programs.

  This position is temporary, scheduled to end in June of 2028.
  

  To be successful in this role, you:

  • Have a Bachelor’s degree in Nursing or a master’s degree in social work and/or a relevant health field required
  • Possess a Current, unrestricted license in the State of Washington as an RN required, if applicable
  • Possess a Current, unrestricted license in the State of Washington as a Social Worker (LSWAA, LSWAIC, LICSW) required, if applicable
  • Possess a Certification as a Case Manager required
  • Possess a current driver’s license and maintain an acceptable driving record is required, as this position involves traveling on behalf of the Company
  • Have a minimum of seven (7) years clinical and case management experience required
  • Have a minimum of three (3) years in a supervisory or management role required
  • Have a minimum of one (1) year coordinating care for justice involved individuals
  • Have experience with identifying, testing and implementing innovative concepts that support justice involved individuals.

  Essential functions and Roles and Responsibilities:

  • Responsible for the daily operation of the Third Party Administrator (TPA) Care Management Program, including staffing and scheduling, to ensure that member outreach is effective and completed within defined timeframes and according to established processes.
  • Ensures that team members are adequately trained to coordinate care and achieve member engagement targets.
  • Establishes and monitors individual and team performance goals, including providing feedback and taking appropriate action to ensure that goals are achieved.
  • Collaborates with carceral facilities to ensure integration of services for members.
  • Conducts site visits to carceral facilities to establish relationships with leaders and staff.
  • Collaborates with Managed Care Organizations and Community Based Organizations to provide education on TPA Care Management services and ensure that services are appropriately coordinated.
  • Responsible for a comprehensive understanding of the Medicaid Transformation Project 2.0 reentry demonstration initiative.
  • Ensures on-going staff development through education and opportunities for professional development.
  • Evaluates and reports program performance in relation to established metrics, and implements changes to effectively drive continual process improvement.
  • Responsible for development and implementation of the TPA care management program in conjunction with TPA Administrator and Care Management leadership.
  • Collaborates with the TPA Administrator and Director, Care Management in budget preparation and makes budgetary recommendations and projections.
  • Monitors, verifies, and reconciles expenditures of budgeted funds. Identifies cost savings opportunities within the department and/or operations.
  • Ensures that all services are delivered consistent with applicable internal policies and procedures, regulatory agency requirements, and standards of practice for care management.
  • Ensures processes and documentation meet regulatory standards.
  • Other duties as assigned. Essential functions listed are not necessarily exhaustive and may be revised by the employer, at its sole discretion.

  Knowledge, Skills, and Abilities:

  • Demonstrated ability to effectively lead and manage teams, including the ability to achieve results through others.
  • Knowledge of the various components of managed care (quality improvement, disease management, population management, utilization management, and case management) and how they link.
  • Well demonstrated project management skills, including the ability to implement new programs.
  • Excellent ‘customer service’ attitude in relationships with enrollees/patients, staff and external partners.
  • Highly effective communicator orally and in writing, with the ability to translate strategy into action.
  • Ability to foster an effective work environment and ensure employees receive recognition, feedback and development.
  • Excellent analytical and problem-solving skills.
  • Able to articulate organizational vision and implement strategic initiatives, with the ability to identify systemic issues to promote real change.
  • Working knowledge of MS office (Word, Excel, Access)
  • Knowledge of regulatory and certification requirements and their impact on the organization (for example, HEDIS, CAHPS, and NCQA).

  As part of our hiring process, the following criteria must be met:

  • Complete and successfully pass a criminal background check.

  Criminal History: includes review of criminal convictions and probation. CHPW does not automatically or categorically exclude persons with a criminal background from employment. The applicant’s criminal history will be reviewed on a case-by-case basis considering the risk to the business, members, and/employees.

  • Has not been sanctioned or excluded from participation in federal or state healthcare programs by a federal or state law enforcement, regulatory, or licensing agency.
  • Vaccination requirement (CHPW offers a process for medical or religious exemptions)
  • Candidates whose disabilities make them unable to meet these requirements are considered fully qualified if they can perform the essential functions of the job with reasonable accommodation.

  Compensation and Benefits:

  The position is FLSA Exempt and is not eligible for overtime. Based on market data, this position grade is 70E. Salary determined at offer will be based on labor market data and a candidate's years of relevant work experience and skills relevant to the position.

  CHPW offers the following benefits for Full and Part-time employees and their dependents:

  • Medical, Prescription, Dental, and Vision
  • Telehealth app
  • Flexible Spending Accounts, Health Savings Accounts
  • Basic Life AD&D, Short and Long-Term Disability
  • Voluntary Life, Critical Care, and Long-Term Care Insurance
  • 401(k) Retirement and generous employer match
  • Employee Assistance Program and Mental Fitness app
  • Financial Coaching, Identity Theft Protection
  • Time off including PTO accrual starting at 17 days per year.
  • 40 hours Community Service volunteer time
  • 10 standard holidays, 2 floating holidays
  • Compassion time off, jury duty pay.

  Sensory/Physical/Mental Requirements:

  Sensory*:

  • Speaking, hearing, near vision, far vision, depth perception, peripheral vision, touch, smell, and balance.

  Physical*:

  • Extended periods of sitting, computer use, talking and possibly standing.
  • Simple grasp, firm grasp, fine manipulation, pinch, finger dexterity, supination/pronation, wrist flexion.
  • Frequent torso/back static position; occasional stooping, bending, and twisting.
  • Some kneeling, pushing, pulling, lifting, and carrying (not over 25 pounds), twisting, and reaching.

  Mental:

  • Must have the ability to learn and prioritize multiple tasks within the scope and guidelines of the position and its applicable licensure requirements, many requiring extremely complex cognitive capabilities. Must be able to manage conflict, communicate effectively and meet time-sensitive deadlines.

  Work Environment:

  Office environment Employees who frequently work in front of computer monitors are at risk for environmental exposure to low-grade radiation.

  Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
  This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.

• About the company

  Community Health Plan of Washington puts you at the center of your care, so when your needs change, we change too. That includes expanding our virtual care services, making personal phone calls to check on you, and providing home delivery of your presc...

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